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Full text of "United States Navy Medical News Letter Vol. 44 No. 9, 13 November 1964"

NOV 1 71964 
NAVMEDP-5088 




Vol. 44 



Friday, 13 November 1964 



No. 9 





CONTENTS 



MEDICAL ABSTRACTS 

Report on the Second Parathyroid Symposium Held in 

the Netherlands 1 

Triage in Management of Radiation Casualties 2 

The Surgical Team — An Important Unit of Naval Medi- 
cal Military Preparedness 4 

FROSTBITE (conclusion) 6 



FROM THE NOTE BOOK 

South Polar Glacier Named for Navy Doctor at Oak 
Knoll 11 



IN MEMORIAM 



DENTAL SECTION 



11 



The Use of Local Anesthesia in the Presence of 
Inflammation 12 

Indications and Contraindications for Endodontic 
Surgery 13 

Correlation Between Plaque and Gingivitis 14 

Mouth Protectors Guard Teeth During Anesthesia 14 



DENTAL SECTION (Cont'd) 

Patient Reaction to Denture Esthetics 
Professional Notes 



14 
14 



PREVENTIVE MEDICINE 

Commission on Malaria of the Armed Forces Epi- 
demiological Board 16 

Fetal Life Study 17 

You Can Prevent Foodborne Illness 18 

Public Health Regulations for the Importation or Re- 
entry of Pets into the United States 20 

RPR Card Test for Syphilis Screening in Field Investi- 
gations 21 

Wasps, Beetle in California Tests for Natural Housefly 

Control 22 

Know Your World 22 

Tick Paralysis-Arkansas „__^ 23 



MISCELLANY 

A Look at Our U. S. Naval Hospitals — Guam, Mariana 
Islands — (Second in a Series. The first in the series; 
was about USNH, Yokosuka.) .Viiiii-24 



:. f'.:m 



United States Navy 
MEDICAL NEWS LETTER 



Vol. 44 



Friday, 13 November 1964 



No, 9 



Rear Admiral Edward C. Kenney MC USN 
Surgeon General 

Rear Admiral R. B. Brown MC USN 
-1 Deputy Surgeon General 

Captain M. W. Arnold MC USN (Ret), Editor 
William A. Kline, Managing Editor 

Contributing Editors 

Aviation Medicine Captain C, E, Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E. Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine CDR J. H. Schulte MC USN 

Reserve Section Captain C. Cummings MC USNR 

Submarine Medicine CDR J. H. Schulte MC USN 



Policy 

The U.S. Navy Medical News Letter is basically an 
official Medical Department publication inviting the 
attention of officers of the Medical Department of the 
Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to 
medicine, dentistry, and allied sciences. The amount 
of information used is only that necessary to inform 
adequately officers of the Medical Department of the 
existence and source of such- information. The items 
used are neither intended to be, nor are they, sus- 



ceptible to use by any officer as a substitute for any 
item or article in its original form. AH readers of the 
News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address 'for the News Letter 
to: Commanding Officer, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new 
addresses. 



FRONT COVER: U.S. NAVY'S HIGH POINT OPERATES SUCCESSFULLY IN ROUGH-WATER TESTS 

The PCH High Point, the U.S. Navy's first operational hydrofoil, is shown during mitial rough-water tests held 
recently off the northwestern most tip of Washington State. The High Point, a 110-ton craft built for the Navy's 
Bureau of Ships by The Boeing Company, was tested in the Strah of Juan de Fuca and in the Pacfic Ocean off 
Cape Flattery. It operated in waves averaging 5^/i. feet (1.67 m) high. Further rough-water tests to gather data 
on the High Point's hydrofoil system will be conducted in the future. The craft is designed to exceed 50 miles an 
hour (80 km/h). 

— From: News Bureau, The Boeing Company, Seattle, Washington 98124 — Boeing Photo. 



The issuance of this publication approved by the Secretary of the Navy on 4 May 1964. 

U.S. NAVY MEDICAL NEWS LETTER 



NOV 1 7 1964 



Report on the Second Parathyroid Symposium 
Held at NOORDWIJK AAN ZEE, THE NETHERLANDS' 

August 25-29, 1964 



By Robert VAN REEN, PhD, Head of the Nutritional Biochemistry Division, Clinical 
Investigation Department Naval Medical Research Institute, NNMC, Bethesda, Md. 



The conference was held under the joint sponsorship 
of Leiden University, the Netherlands, and Rice Uni- 
versity, Houston, Texas. Attendance at the symposium 
was limited to speakers and invited participants. The 
program was divided into two broad areas: (!) The 
Parathyroid Gland: the fine structure, the histochemis- 
try, regulation of secretion, and the chemistry of the 
hormone and (2) The Mode of Action of Parathyroid 
Hormone(s): the influence on homeostatic mechanisms, 
the influence on transport and ion exchange, the in- 
fluence at the tissue level, the influence on cell 
organelles, and the influence on metabolic pathways and 
individual enzyme activities. 

Several of the reports were of particular interest. 
Drs. J. T. Potts, Jr. and G. D. Aurbach of the National 
Institutes of Health have purified the parathyroid hor- 
mone and reported on its chemical structure. The 
hormone appears to be a single chain polypeptide of 
molecular weight about 9000 containing no cystine but 
a total of 75 amino acid residues. The carboxyl termi- 
nal group is due to leucine and the amino end group, 
alanine. Dr. Aurbach also reported a new method of 
analysis for the purified hormone which can be used 
for the assay of from 7 x 10" to 10 ""M of parathor- 
mone. 

Two papers concerning the newly discovered hor- 
mone, calcitonin, were quite interesting since it now 
appears that there are two hormones controlling calcium 
levels in the serum, with parathormone tending to 
increase the concentration and calcitonin acting to 
lower it. Dr. D. H. Copp of the University of British 
Columbia and his group have developed techniques for 
in-vivo perfusion by which the thyroid gland or the 
parathyroids can be perfused with high calcium solu- 
tions or with ethylenediamintetracetic acid to produce 
low calcium solutions. Dr. Copp feels that the para- 



* Submitted to the Medical News Letter by CAPT John R. Seal MC 
USN, Commanding Officer of the Naval Medical Research Institute. 

U.S. NAVY MEDICAL NEWS LETTER 



thyroid gland of sheep can be the source of calcitonin 
since he gets a reduction in peripheral serum calcium 
when the parathyroid is perfused with high calcium and 
also observes an effect in thyroidectomized animals. Dr. 
I. Maclntyre of the Postgraduate Medical School of 
London presented extensive data to demonstrate that the 
thyroid gland produces a material which lowers serum 
calcium levels. He has purified hog thyroid and has 
obtained a material which is stable to boiling at neu- 
trality. The active material appears to be a polypeptide 
having a molecular weight of about 3000. In general 
it appears that Dr. Maclntyre's calcitonin from the 
thyroid is a real observation. Whether there is a similar 
material produced by the parathyroid glands must await 
further data. 

Dr. P. Goldhaber of Harvard University presented a 
beautiful time-lapse film showing the formation of giant 
osteoclasts through the fusion of smaller cells and 
which also clearly demonstrated the resorption of bony 
spicules by giant osteoclasts. He also reported data 
which indicate that heparin potentiates the action of 
parathyroid hormone in causing the resorption of cal- 
cium from mouse calvaria in tissue culture. Dr. G. 
Nichols, Jr. of Harvard Medical School indicated that 
in his clinical work a number of patients being treated 
with heparin for cardiovascular disease have developed 
osteoporosis. Dr. Goldhaber mentioned that others have 
shown that do)>s given serial injections of heparin de- 
velop spontaneous fractures. 

Several papers were presented on the influence of 
parathyroid extracts on biochemical systems with the 
idea of trying to find some parathormone-responsive 
system which might be related to the rapid dissolution of 
calcium from apatite. Several speakers were con- 
cerned with citric acid metabolism in bone, since citrate 
levels increase in response to parathormone injections 
and citrate will chelate with calcium. I presented the 

|.;;rn-n-' CRNERAL HOSPiTAl 



1 



I I . . 



ur 



U. S. ARfviy 



work performed at the Naval Medical Research Insti- 
tute which showed that although citric acid increases, 
the enzymes responsible for the further metabolism of 
citric acid are not altered by parathormone and, sur- 
prisingly, the coenzyme for one of the enzymes, isocitric 
dehydrogenase, actually increases in concentration in 
bone. Possible mechanisms of the action of parathor- 



mone were presented. 

One afternoon was spent visiting the facilities of the 
Laboratorium voor Celbiologie en Histologie of Leiden 
University which is under the direction of Professor 
P. J. Gaillard and which carries out a broad program 
on tissue culture, bone growth and development, and 
bone metabolism. 



Triage in Management of Radiation Casualties 



CAPT Theodore H. Wilson, Jr., MC USN*. From the Proceedings of the Monthly Staff 
Conferences of the U. S. Naval Hospital, NNMC, Bethesda, Md. Sept 1963-lune 1964. 



When we undertake to discuss such a topic as the 
one now under consideration, we can do so quite un- 
encumbered by experience. The only persons who can 
speak with authority are those Japanese who lived 
through the bombings of Hiroshima and Nagasaki. 
Those who draw conclusions from past military actions, 
from laboratory study, and from field tests possibly can 
approximate the truth and provide us with some factual 
background for the plans we are forced to make, but 
experience is lacking. The sincere efforts made by 
the armed services and Civil Defense officials to provide 
some sort of reasonable approach to the problem are 
noteworthy, but we cannot be certain we are right. 

We are charged with the responsibility of salvaging 
as many persons as possible after nuclear weapons strike 
either our military or civilian populations. Our first 
reaction may be one of complete despair, feeling that 
the magnitude of the problem is overwhelming and 
incapable of solution. Or we may wish the problem 
away, promising ourselves that such a disaster could 
never occur or that an impasse exists between the great 
nuclear powers which precludes the use of atomic 
weapons. We may, on the other hand, calculate our 
needs in precise detail and recommend stockpiles of 
medical equipment and supplies so enormous as to be 
burdensome. It seems incumbent upon us to try to 
arrive at a reasonable compromise, therefore, reaching 
the most with what we consider adequate care. My own 
personal conviction is that we would be better off 
in the long run to expend our energies in those areas 
concerned with the prevention of nuclear war rather 
than in seeking answers to problems we believe are not 
only unlikely to occur, but are inevitable. 



• Doctor Wilson is Assistant Chief of tlse Surgical Service of the 
USNH, NNMC, Bethesda, Md. 



However, we must also give thought to the ever- 
increasing possibilities of numbers of persons being 
simultaneously injured in laboratory and industrial acci- 
dents where irradiation is involved, since similar prob- 
lems may be encountered as in the military situation. 

It is imperative, therefore, to review briefly the effects 
of irradiation on the body. Gamma rays can penerate 
tissues, breaking down cell nuclear integrity, coagulat- 
ing protein, destroying sulfhydryl bonds, and blocking 
DNA production so cell division cannot proceed. Neu- 
trons may cause sodium, phosphorus, and water in the 
body to become radioactive and hence locally destruc- 
tive. Alpha and beta particles, effective at short range, 
exert a deleterious action on cells in similar manner. 
Among the cells most easily damaged are those with 
a rapid "turnover," such as cells of intestinal mucosa, 
marrow, spleen, and gonads. Accordingly, the symp- 
toms of whole-body irradiation include nausea, vomiting, 
bloody diarrhea, falling WBC, lymphopema, eventual 
anemia and pancytopenia, purpura, inability to resist 
infection, sterility or sex cell mutation, plus a variety 
of other manifestations. 

It is apparent that wounds complicated by irradiation 
are especially dangerous because the body's healing 
potential is greatly depressed, with the possibility of 
invasive infection greatly increased. 

As for the effects of nuclear weapons on persons, 
they are well known. The closer one is to the epicenter, 
the greater the lethal effect of blast, heat, and ionizing 
irradiation. Farther away, heat may damage with flash 
burns or burns occasioned as clothing, buildings, or 
furnishings ignite. Blast may have an effect on ears, 
lungs, and other viscera, but far more damage is done 
by flying and falling objects, including glass and ma- 



U.S. NAVY MEDICAL NEWS LETTER 



sonry. Irradiation may strike directly with a lethal or 
sub-lethal whole-body effect, with or without associated 
mechanical or thermal injuries, or its damage may come 
later with fallout. 

To determine in what proportion we could expect 
these injuries to occur, we can turn to the experience of 
the Japanese. It was evident, of course, that many were 
killed outright. Among the living, physical injuries were 
common, with cuts and bruises and shock from blood 
loss, much due to flying glass. There were fractures, 
but not as many as could not escape the fires that fol- 
lowed quickly after the blast. Eye injuries did not seem 
common and ruptured ear drums were seen in only 
8 of 370 admissions to an Hiroshima hospital. Flash 
burns were common and secondary infection was the 
rule. Irradiation injuries were noted in about 15% of 
casualties, and seemed to fall into four fairly distinct 
groups depending on dosage received. Group I died 
within two weeks, with the "gut syndrome" dominant. 
Group II died during the third to sixth week chiefly of 
aplastic anemia and infection. Group III died after the 
sixth week with the late effects of infection, and it 
would appear that the secondary effects of blast and 
thermal effects will be the chief problems. One com- 
pilation suggests that blast accounted for 60% of the 
Japanese casualties, with thermal 25% and irradiation 
15%. Exact figures are not important. What is im- 
portant is that enormous numbers of persons were hurt 
simultaneously, and that blasts effectively incapacitated 
nearly 90% of the available medical manpower {doctors 
and nurses) and destroyed most of the hospitals. 

Now, given such data, and trying to learn from them 
we can accept the following to be true: 1. There may 
be a great disparity between the numbers of injured and 
the medical facilities for handhng them. 2. The dis- 
tribution of medical facilities in relation to the casualties 
may permit grossly unequal patient-loads. 3. Panic, 
immobility of a stunned population, the disruption of 
communications, traffic flow, and public utilities will 
hinder rescue efforts and efficient distribution of casual- 
ties. 

Despite these hindrances, some plans must be drawn 
and disseminated. We feel that the principle of triage is 
of great importance in dealing with large numbers of 
injured. Triage means sorting. It begins with the nat- 
ural gross sorting of dead and living immediately after 
a catastrophe. Among the living will be those who, for 
one reason or another, never get into the chain of 
evacuation and never receive treatment except that 
which they give themselves. Within the disaster area we 
can expect numerous examples of first aid, some effec- 
tive, some not, rendered by person to person with what- 
ever material is at hand. In theory, it would be ideal 
to establish quickly about the disaster perimeter nu- 
merous aid stations where medical or paramedical per- 
sonnel tould sort out casualties, treating the simple 
problems and establishing priorities for evacuation of 
the more seriously hurt. Again, ideally, a little farther 



out, lines of evacuation should converge on improvised 
hospitals or holding stations where casualties could be 
further sorted and prepared for further evacuation to 
general hospitals for definitive care. All along the line, 
natural triage occurs, as persons die or conditions de- 
teriorate. 

We believe that triage requires mature judgment to 
be effective since decisions must be made rapidly with 
little time for careful examination. We believe that 
triage should be done, especially at the level of the hos- 
pitals, by the most experienced surgeons available. Cur- 
rent thought suggests that patients should be grouped 
into four categories, and moved and treated accord- 
ingly. GROUP I includes those with minimal injury, 
such as small cuts, bruises, fractured small bones, and 
second degree burns under 10% of body surface. It 
also includes those who need only domiciliary care. 
GROUP II requires IMMEDIATE care, such as hemor- 
rhage from easily-accessible sites, rapidly correctible 
mechanical respiratory defects, severe crushing wounds 
of extremities, incomplete amputations, and compound 
fractures of major bones. GROUP III can afford to 
have treatment DELAYED. Patients with moderate 
lacerations without great blood loss, closed fractures, 
non-critical central nervous system injuries, and burns 
of 15% to 40% of the body surface will not necessarily 
suffer great harm if their treatment cannot begin for 
several hours. GROUP IV patients are to be treated 
EXPECTANTLY, since their injuries are so severe that 
salvage is unlikely even with unlimited time, resources, 
and personnel. In this group belong those with critical 
chest or central nervous system injuries, burns over 40% 
of the body, major abdominal wounds and multiple 
severe wounds. 

This system of continuous sorting can never be per- 
fect. Gross errors must inevitably be made, but, in all 
probability, more will be helped than harmed. Many 
who would live had they come alone to a hospital where 
all manner of talent and equipment could be mobilized 
must be put into Group IV simply because many less 
seriously hurt can be positively helped with the same 
expenditure of energy and supplies needed for the one. 
For young physicians, trained in civilian as well as mili- 
tary hospitals, the natural tendency is to center attention 
on the critically injured, and it is difficult to grasp the 
necessity of turning such persons away in favor of the 
less seriously hurt. 

The successful management of large numbers of cas- 
ualties would appear to depend on several key elements: 

1. The medical organization must be simple and flex- 
ible. 

2. There must be mobility of medical units. 

3. Communications must be good. 

4. There must be reserve support. 

5. Personnel must be versatile. 

6. Supplies must be simple and available. 

7. Procedures must be standardized. 



U.S. NAVY MEDICAL NEWS LETTER 



8, People must be trained, or catastrophe will stun 
them and make them useless. 

There is as yet no good way to neutralize the effects 
of radiation. There is experimental evidence that mar- 
row or splenic homogenate can protect animals even 
after irradiation and mice given glutathione, which is 
rich in sufhydryl groups, may resist the effects of irradi- 
ation. We have no good way to tell whether a person 
has been exposed to ionizing radiation except for dosi- 
meters, and we cannot expect these to be in general use. 
When a lethal dose of roentgens is delivered, death will 
ensue, and drugs, blood, and dressings might just as well 
be used for someone else. 

We are, of course, concerned with the effects of 
"fallout", but when large numbers of persons are hurt 
and simultaneously covered with active dust, we will 
probably not be able to offer much in the way of de- 



contamination beyond removal of victims' clothing and 
the washing of exposed skin and hair. Wounds, of 
course, can be lavaged, provided, water sources are 
clean. 

The topic is unpleasant, the solutions are tentative, 
and one cannot help but feel that our energies should 
be spent seeking PREVENTION rather than CURE. 

Useful Bibliography 

1. The Effects of Nuclear Weapons (Revised Edition). Prepared by 
the U.S. Department of Defense and published by the U. S. Atomic 
Energy Commission, April 1962. For sale by the Superintendent of 
Documenis, U.S. Govt Printing Office, Washington, D. C. 20402. 
Price $3.00 (paper bound) 

2. Joint Commission for Investigation of the Atomic Bomb in Japan. 
The section published in 1W7 by Liebow and Warren, entitled, 
"Pathology of Atomic Bomb Casulaties," is valuable. 

3. The Physician in Atomic Defense, by Thad Sears, Associated 
Clinical Medicine, published in 1953, contains a non-military man's 
views concerning the management of radiation casualties. 

4. Medical Management of Casualties in Nuclear Warfare, NAVMED 
P-S046; AFP 160-2^; TB MED 246; 4 Dec 1963, 



The Surgical Team 

AN IMPORTANT UNIT OF NAVAL MEDICAL MILITARY 
PREPAREDNESS 



CAPT Robert P. Dobbie, Jr. MC USN*. From the Proceedings of the Monthly Staff Con- 
ferences of the U. S. Naval Hospital, NNMC, Bethesda, Md., Sept 1963-June 1964. 



In this era of medical specialization, many of us have 
found ourselves primarily assigned to Naval Hospitals. 
Here we are encouraged to refine our specialties and 
devote our entire attention to a relatively small frag- 
ment of Naval Medical practice. Under these circum- 
stances, it is all too easy to forget that the original and 
specific mission of the Medical Department of the Navy, 
as a whole, and each one of us as individuals, is "to 
keep as many men at as many guns as many days as 
possible." The bellicose ring to these words should 
help remind us that we have important military medical 
responsibilities even in time of relative peace. 

Medical support for the Marine Corps as well as for 
the Fleet has always been the responsibility of the Navy 
Medical Corps. When a Marine unit is not actively 
employed in a combat situation, it is unnecessary to have 
its full complement of physicians and other medical per- 
sonnel physically present constantly. This means that 
in preparation for combat, the shortage of physicians 
and medical personnel would have to be made up by 
augmentation from the peacetime naval hospital staff. 
Thus, various individuals in naval hospitals are placed 
on augmentation teams for the purpose of filling out 



* At the time of this presentation Doctor Dobbie was a Staff Member 
of the Surgical Service, USNH, NNMC, Bethesda, Md. He now 
serves as Chief of the Surgical Service, USNH, Memphis, Tenn. 



the Table of Organization of Marine units, if and when 
there isr need. When used, members of augmentation 
teams do not function as a team but are absorbed as 
individuals into the basic Marine Medical Structure. 

World War II, the Korean War, and the development 
of modern surgery itself have shown that in many in- 
stances it is more practical to bring the operating room 
to the patient rather than bring the patient to the operat- 
ing room. The concept of performance of urgent major 
surgery shortly after wounding, and close to the geo- 
graphic place of wounding, has stimulated the creation 
and development of the Surgical Team. A surgical team 
as now organized consists of three physicians and ten 
corpsmen — 13 men; one fully-qualified general sur- 
geon; one fully-qualified orthopedic surgeon; one fully- 
qualified anesthesiologist; six operating room techni- 
cians; two general service corpsmen; one field medical 
technician; and one laboratory technician. A surgical 
team is designed to function as a unit and is to be 
employed as a unit. It can provide all the manpower 
and supplies necessary to operate one added operating 
room anywhere ashore or afloat. Its men and material 
are completely mobile and can be moved rapidly from 
place to place as need dictates. Its function therefore 
is to provide additional surgical support where actual 
or expected surgical need is in excess of the capability 



U.S. NAVY MEDICAL NEWS LETTER 



of the indigenous medical facility. Thus, a surgical team 
could be assigned to a Marine collecting and clearing 
company and would double its surgical capability to an 
AKA or APA where that ship could thus become a 
small surgical hospital, or to a hospital ship or fixed field 
hospital staggering under an acute surgical overload. 

In times of civil disaster, a surgical team could be 
sent to assist a local hospital or to set up in a school 
or church, and with the aid of the local medical per- 
sonnel add significant increased surgical capability. 

The men and material of a surgical team are in effect 
a mobile operating room. A surgical team is not de- 
signed to operate alone, but must be satellited on some 
existing basic medical facility. To operate it must have 
provided for it: shelter, power, water, sterilization 
capability, laundry, and basic personnel maintenance, 
such as messing facilities. In addition, the full man- 
power and materia) of a surgical team will be required 
to keep the one operating room functioning at maximum 
efficient capacity. Personnel for triage, preoperative 
care, postoperative care, special study (x-ray), and pa- 
tient transportation and evacuation must be provided by 
the parent organization to which the surgical team is 
temporarily assigned. 

Thus, though a surgical team will function as a team 
in the full sense of the word, it cannot be put to maxi- 
mum efficient use if employed alone or without basic 
support. 

When in the field acting in support of a collecting and 
clearing company, a surgical team is usually provided 
with two general purpose tents. These tents can be 
arranged in a variety of ways to suit traffic pattern and 
terrain, but essentially one tent becomes the operating 
room and the other becomes the CSR (Central Supply 
Room). Excess space in both tents can be used for Lab 
and for minimal pre and postoperative holding. The 
surgical team equipment is packed in 40-plus field 
medical chests. Each chest weighs less than 200 pounds 



and is easily handled by two men. Each chest should 
be functionally packed and combinations of stacked 
chests can be used for storage shelves in the OR and 
CSR. The material includes instruments, suture, linen, 
dressings, I. V. fluids, medications and specific basic 
operating room equipment, such as OR table, spotlight, 
anesthesia machine, and suction apparatus. All of the 
equipment together is referred to as the Surgical Team 
Supply Block. The total weight of the Block is about 
5,500 pounds. It is easily transportable by any convey- 
ance including most transport aircraft. The material con- 
tained in this allowance provides consumable and non- 
consumable supplies for support of a Surgical Team for 
10 days. Surgical Team Re-Supply Blocks provide con- 
sumable items for a 10-day re-supply support of a 
surgical team. 

The operating room is usually set up for the simul- 
taneous use of two tables. The tables are set up in a 
"V" fashion providing the anesthesiologist easy access to 
the "head" of each table at the point of the "V" and 
enough room for a surgeon and one assistant to attend 
to the necessary surgery at each table. Considering 
two-table operation with one surgeon, one assistant (OR 
tech) one scrub corpsman (OR tech), and one circulat- 
ing corpsman (OR tech) to service each table, and 
three corpsmen (general and field service) working 
CSR and the Lab man obtaining blood, it is easy to see 
how small a surgical team really is and the essential 
need for support in terms of triage, pre and postopera- 
tive care and transport and evacuation. 

The Commanding Officer of the sponsoring hospital is 
in military command of, and responsible for, the ad- 
ministrative support and training of the surgical team 
until deployed. Once deployed for operation with a 
fleet or overseas unit, the surgical team comes under the 
military command of the Operating Fleet Commander 
who is responsible for the administrative and logistic 
support of the team. The ranking medical officer of 
each surgical team is in charge of his team. 



YEMENI HEALTH PIONEERS 

Ten students from Yemen — a country with an acute 
shortage, of doctors — have been awarded fellowshipr by 
WHO to study medicine and pharmacy in the United 
Arab Republic. - •" ;- 

This is the largest number of fellowships ever award- 
ed at one time by the WHO Regional Office for the 
Eastern Mediterranean to students from the same coun- 
try. Nine of the fellows from Yemen will study medi- 
cine in the Universities of Alexandria (2), Cairo (3), 
and Ain Shams, in Cairo (4). The remaining fellow is 
the first Yemeni candidate for a pharmacy diploma, and 
is studying at Alexandria University. 



Another batch of 10 Yemeni students are already 
undergoing their medical training in the United Arab 
Republic under WHO sponsorship. The first Yemeni 
physicians completed training in Cairo in 1959. Until 
then, foreign doctors made up almost the entire skilled 
staff of Yemen's three hospitals. Assisting the few 
physicians are a growing number of Yemeni hakims, 
or medical assistants, who serve a kind of apprentice- 
ship under foreign and local advisers, including WHO 
experts. 

Altogether 87 fellowships for study abroad have been 
awarded during the past ten years to students from 
Yemen as part of WHO'S long-range assistance to that 
country.— WHO Chronicle, 18(3): 108 March 1964. 



U.S. NAVY MEDICAL NEWS LETTER 



FROSTBITE' 



By Bradford Washburn 
Director, Museum of Science, Boston, Mass. 

(This article is reproduced from The Polar Record, Vol. H, No. 75, September 1963, 
by kind permission of the author and the editor of that journal. It originally appeared 
in the American Alpine Journal 13: 1-26. June 1962, and was reproduced, in slightly 
different form, in the New England Journal of Medicine 266: 974-989, May 10. 1962. 
This article is a slightly shorter version containing subject matter from both originals. 
Appreciation is extended to Mr. Washburn for permission to publish this article in the 
Medical News Letter. — Editor) 



TREATMENT 



Only superficial "frost nip" can be treated effectively 
enough in the field to make it possible for a person to 
continue on the trail. This is the only kind of frost- 
bite that can be considered medically inconsequential. 
It is usually encountered in high wind or extreme cold 
(or both) on the nose, cheeks, chin, ears, fingers or 
toes. If sudden blanching of the skin is noticed prompt- 
ly it can usually be treated effectively and completely on 
the spot by firm, steady pressure (not rubbing) of a 
warm hand, or by cupping one's hand over the spot 
and blowing on it until it returns to normal colour. One 
can very effectively rewarm frost-nipped finger-tips by 
holding them motionless in the armpit — either of the 
patient himself or a companion. Although toes can be 
nipped superficially just like the face or fingers, this is 
much more difficult to identify than the latter before 
the injury has progressed beyond the point where it 
can be treated easily and quickly. 

One fairly reliable symptom of incipient frostbite in 
fingers or toes is the sudden and complete cessation of 
cold or discomfort in the injured spot, often followed 
by a pleasant feeling of warmth. If this prime danger 
signal is instantly heeded, frost nip will never develop 
into real frostbite. However, it is important to note that 
many serious cases of frostbitten feet have now been 
recorded in which there was no preliminary period of 
anaesthesia. Some people seem to "feel" cold much 
more than others. 



* Continued from Vol. 44, No. 8, October 23, 1964. This is the third 
and final installment. 



The only practical way to treat nipped toes or heels 
on the trail is to remove footgear the moment there 
is any suspicion of danger and to rewarm them imme- 
diately on the belly of a trailmate, protecting them 
from wind by keeping them well covered by parka and 
shirt during the process. After thawing is complete the 
patient should change to dry socks and dry insoles and 
lace footgear back on very loosely to ensure adequate 
circulation and warmth. 

The "buddy system" of constantly watching the faces 
of one's partners is the best way to identify a frost- 
nipped face, since this injury cannot be seen or felt 
by the patient himself. Constant personal vigilance is 
the only way to avert trouble in one's own fingers and 
feet. When in doubt, one should investigate thoroughly 
before it is too late. 

These suggestions are only for extremely superficial 
frost nip. In all cases of bona fide frostbite every effort 
should be made to get the patient to the best available 
camp and then to a good hospital as soon as possible. 
If evacuation to civilization cannot be speedy, the 
patient should be taken to a low camp with reasonable 
comfort, equable temperatures, good food and total 
rest and kept there until a competent physician can 
take charge. Slow and inadequate rewarming on the 
trail, often followed by refreezing, can cause so much 
damage and later complications that it appears to be 
best to postpone all efforts to thaw injured parts, even 
for many hours, if by so doing one can get the patient 
to a place where thorough and rapid rewarming in a 

U.S. NA'VY MEDICAL NEWS LETTER 



'I 



deep vessel of water can be effected, and where adequate 
warmth and reasonable comfort can be maintained 
afterwards. 

If an accident has resulted in leg or arm fractures in 
extreme cold, traction in outdoor first aid should not 
be administered, or frostbite may develop rapidly in the 
extremities beyond the injury. A well-padded temporary 
splint to immobilize the fracture should be used. A shoe 
should never be left on the foot below a sprain or 
fracture — it is the worst sort of insulation, and it should 
be replaced by other soft, dry clothing. All extremities 
should be constantly watched distal to fractures or deep 
cuts, and one should be sure that splints or bandaging is 
not applied so tightly that circulation is impaired. 
Whether or not there has been an adjacent injury, 
special care should be taken to assure the best possible 
circulation to the frostbitten area. 

One should not try to rewarm frostbite on the trail. 
The patient is treated for exposure if an accident is 
involved. He must not smoke or drink alcohol, and 
should be taken to as low and comfortable a camp as 
possible immediately after frostbite has been discovered, 
unless there is a very good chance of evacuation by 
litter or helicopter. Contrary to general belief, a strong 
patient can walk a long way on frozen feet without 
further injury to them — and by so doing not only get 
himself down to a better site for recovery but also 
save his companions the difficult (and sometimes dan- 
gerous) task of dragging or carrying him down after 
thawing has rendered it impossible for him to walk at 
all. It must be remembered that if a frozen foot or toe 
is rewarmed on the trail, the patient immediately be- 
comes a litter case. He cannot assist in his own rescue 
and may create a major crisis not only for himself but 
also for his comrades. 

No patient should ever be permitted to walk at all 
on thawed feet or toes, since very serious loss of tissue 
is almost certain to result. 

Here, I think it would be wise to quote directly from 
a recent letter of a top authority in the treatment of 
frostbite (Mills, 1961) — in Anchorage, Alaska, an area 
where a great deal of cold injury may be expected as 
regular winter routine: 

Unless you have an adequate method for transporting 
the patient down, either by helicopter or by sled so 
that he himself need not use his hands or feet, I think I 
would discourage thawing, at 18,000 ft — he would be 
wise to stump his way down with frozen, unthawed 
feet even if it took 12-18 hours, as long as the ob- 
jective was adequate shelter, reasonable comfort and 
a spot from which he could be flown or carried to a 
hospital. We have had a half dozen patients who 
have walked for three or four days with completely 
frozen extremities — some of whom have sustained no 
loss at all. Others lost toes only. In no case did any 
of them lose any more of the foot than toes. There 
appears to be an opportunity even to preserve all 
of the digits, provided that as soon as the patient 



reaches a place where thawing can be managed, it is 
done by the method of rapid rewarm ing, followed by 
the regular routine of aseptic hospital care. 

Once the patient has reached the site where he is 
to be thawed, two basic treaments should proceed 
simultaneously; first for exposure, second for frostbite. 
While the largest possible vessel of water is being 
warmed to 42° to 44°C (108° to 112°F) the entire 
body of the injured man should be warmed as much 
as possible. It is obviously valuable to have at least 
one large water vessel (2 to 3 gal) in camp for medical 
use, in addition to its basic daily value for melting 
snow water and for dishwashing. A rectangular 5-gal 
gasoline can with the top or side (best) removed is 
an ideal container for both uses and very light to carry. 
An injured person can rarely maintain his own body 
heat in extreme cold and at rest without outside help, 
and camp is usually very cold when a party first reaches 
it after a frostbite accident. 

Merely bundling up the patient in additional clothing, 
cold blankets or even a cold sleeping bag will rarely 
even maintain existing body warmth. Active rewarming 
is required. Hot liquids should be administered as soon 
as possible. The patient should be protected between 
two warm people under blankets after removal of cold 
outer clothing — someone should get into a large sleep- 
ing bag with him, or he should be put into a sleeping 
bag already warmed by someone else and kept con- 
stantly warm throughout treatment. He should not be 
permitted to smoke or drink alcohol until heahng is 
completed. The one brief moment in frostbite treatment 
when use of an alcoholic beverage may be advantageous 
occurs actually while rewarming is taking place — ^but 
only if the patient has reached an environment where 
he will remain constantly warm thereafter. 

All clothing should be removed from the injured 
part, which is placed in the warm-water bath when 
it has been prepared and its temperature carefully 
checked. A rugged thermometer reading to approxi- 
mately 65°C (150°F) should always be carried as a 
part of the first-aid kit for this purpose. 

If a large enough container is not available to hold 
the injured part completely immersed the part should 
be wrapped in towels and warm water constantly 
poured over them — great care being taken never to 
have the water warmer than 44 °C (I12°F). 

With young, heaUhy patients, initial rewarming from 
a frozen state involves very little discomfort for the 
first ten minutes. Pain slowly increases, however, 
until at the end of the rewarming period, it is extremely 
uncomfortable but not unbearable. Older patients and 
those suffering from circulatory ailments may experience 
much more pain than others. 

The relief of pain during the rewarming presents a 
delicate problem in the field, particularly at high alti- 
tude and in cases involving shock and exposure. 

No pain-relieving drugs, except two regular 0.3 
Gram (5 grain) aspirin tablets, should be administered 



U.S. NAVY MEDICAL NEWS LETTER 



if the patient is suffering from injuries in addition to 
frostbite, if he is in a distraught or weakened state or 
if his temperature is below 36°C (97°F). 

If the patient is in good condition, in addition to 
aspirin he may be simultaneously given one 25 mg 
meperidine (Demerol) tablet fifteen to thirty minutes 
before re warming starts. The use of further medication 
to reduce this pain in the field is considered inadvisa- 
ble, because of the danger of bringing on severe respira- 
tory depression — particularly at altitudes above 10,000 
ft. 

After rewarming is completed, it is strongly recom- 
mended not to employ any drug except aspirin for relief 
of pain during the long convalescence. Two 0.3G 
(5 gr) tablets may be taken at intervals of two to four 
hours as needed. This treatment will reduce pain sub- 
stantially without having any collateral ill-effects on the 
healing process. 

It is safe to help to induce sleep by means of two 
250 mg chloral hydrate capsules at bedtime. One 
more capsule may be given three or four hours later, 
if necessary. Under no circumstances should more than 
four of these small capsules (a total of 1 full Gram) 
be given in any single twenty-four hour period. It 
appears as if chloral hydrate, unlike narcotics, may be 
used safely at any altitude. 

Rewarming in liquid should last about twenty 
minutes. Apparently there is no value in rewarming 
longer than this, if it is done in an ample supply of 
water at the proper temperature. One must be sure 
that this is done in enough water (a big bucket) to 
prevent the frozen part itself from cooling the liquid 
below 42°C (i08°F) and, if possible, keep checking 
the temperature of the water in the container adjacent 
to the injured part and keep adding water to retain the 
desired temperature throughout the rewarming period. 
One should never add water over 46°C (115°F) and 
should take great care not to pour added hot water 
into the rewarming vessel too close to the injured part. 

The value of rapid and through rewarming at a 
location where the patient can remain warm, com- 
fortable and at rest continuously afterward is so clear 
that all other efforts at rewarming should be postponed 
for a considerable time, if this delay will assure doing 
the job properly (Yoshimura and others, 1960; Mills, 
and others, 1960). 

However, if liquid rewarming is impossible, the part 
is placed against a warm abdomen, or under the armpit, 
held in warm hands, exposed to warm air or wrapped 
loosely in warm clothes or blankets after careful cover- 
ing with sterile bandages to minimize even the slightest 
friction. Dry rewarming of this sort should be com- 
pleted in a single continuous operation, which may take 
three or four times as long as the liquid procedure to 
do the job completely. 

One should never try to rewarm a frozen part by 
exercising it. If it is really frozen, this will not thaw it. 



and it will almost certainly increase the extent of the 
injury, 

A frozen part should never be rubbed before, during 
or after rewarming or rubbed with snow or thawed in 
cold water. Applying ice water or snow to a frostbitten 
limb makes about as much sense as treating a burned 
foot by putting it in an oven! (Mills, 1961). 

Never expose a frozen part to an open fire, really hot 
water or any other intense form of heat. Excessive use 
of dry heat in rewarming appears to produce almost 
certain additional injury and possible gangrene; the 
injured part is suffering from either partial or total 
temporary anaesthesia, as in a burn, and will not be 
able to judge for itself the degree of heat to which it 
is being subjected. It may easily suffer severe additional 
injury while being thawed out, if this is not done very 
carefully. If rapid rewarming in water is to be used, 
one should be sure to check the water temperature 
with a thermometer or the hand of an uninjured mem- 
ber of the party. The patient should never be permitted 
to test the temperature with the frozen part. 

After rewarming has been completed, general body 
warmth is maintained throughout convalescence. If 
the patient must unavoidably stay in a tent, stoves are 
kept going continuously night and day, to assure a 
constant, equable temperature. 

The injured part is thoroughly cleaned as soon as 
rewarming has been completed, a mild non-alcoholic 
antiseptic or very mild soap — administered with 
thoroughly boiled water — being used. One should not 
rub Of scrub — dirt is dabbed off very gently with sterile 
absorbent cotton, facial tissue or the softest available 
cloth (also boiled). Antiseptics involving alcohol should 
not be used, since they not only may be very painful 
but are also likely to do further damage to delicate 
injured tissues. 

Ultimate success in the treatment of frostbite appears 
to depend largely on two factors: the exercise of ex- 
treme care during the after rewarming, so that the 
delicate injured part is not further damaged in any 
way; and the prevention of infection, which becomes 
the paramount issue from the time of rewarming to 
the conclusion of the treatment. 

The injured part is kept open to the air, as long as it 
is warm and nothing touches it. After rewarming, it is 
not maintained above normal body heat. When it 
must be covered, loose, soft, dry dressings are used, 
never greasy, oily dressings. Dry, soft absorbent cotton 
between toes or fingers will prevent friction between 
injured parts and protect delicate tissue from further 
damage. A pillow placed behind the calf of the leg will 
keep the foot or heel off the sheet. Even light pressure 
from sheets or tight dressings can increase damage and 
ultimate loss of tissue. Whether the injured man is 
cared for in a hospital bed or in a sleeping bag, one 
should be sure to protect the injured foot or hand from 
the pressure of the bag or sheets by putting a small 
box or other frame in the bag with the patient. 



8 



U.S. NAVY MEDICAL NEWS LETTER 



Blisters are never pricked or opened. In fact, the 
part is left completeiy alone except for changes in 
dressings — and they are not changed unless they have 
become very dirty. 

The most vigorous possible efforts should be made so 
get the patient to both doctor and hospital. However, 
if severe frostbite is encountered in a place whence it is 
impossible to move the patient rapidly to a hospital, or 
to bring an experienced doctor to him, the following 
additional precautions should be taken while the un- 
avoidably lengthy process of healing is being waited 
out. 

The patient is kept entirely still, no matter where 
the injury, until swelling has completely subsided and 
blisters and sores have dried up. The injured part 
should probably be kept horizontal (rather than up or 
down) during treatment, though there may be some 
value in depressing it slightly or lowering and raising it 
periodically to improve general circulation as recovery 
progresses. 

Open sores and oozing blisters are cleaned occasional- 
ly with a mild, non-alcoholic antiseptic or very mild 
soap, exactly as recommended above for immediate 
post-rewarming treatment. One should dab rather than 
rub — and do this extremely gently to minimize friction. 
Even this may be poor surgical policy. If the injured 
part appears to be reasonably clean, it is better not to 
tamper with it at all. 

When infection is unquestionably present, the use 
of a "broad-spectrum" antibiotic by mouth is recom- 
mended. Many of those that might normally be used 
in a controlled hospital situation are undesirable or 
downright dangerous when used in the field because 
of their side effects. 

DemethylchJortetracycline (Declomycin) appears at 
present to be the best choice, administered in doses of 
one 150 mg capsule every four hours for four days, and 
one every six hours for a week if progress is satisfactory 
and till infection is under full control. If persistent 
diarrhoea appears, treament is stopped for thirty-six 
hours and then resumed at half the previous dosage. 

One should never cut off any tissue but should let 
nature effect its own removal. It is virtually impossible, 
even for an expert and after weeks of treatment, to 
determine the depth of frostbite injury from examina- 
tion of the condition at the surface. Even minor surgery 
will expose underlying layers of damaged tissue and 
greatly increase the danger of infection to them. 
Seriously injured tissue often survives almostly mirac- 
ulously, if not disturbed and kept scrupulously clean 
and free of infection and irritation. 

Physiotherapy should never be attempted in the field 
by anyone but the patient himself. Frequent gentle 
movement of all joints of the part involved will help 
maintain flexibility of the muscles, tendons and liga- 
ments — but this must be done very carefully so as 
not to result in friction or further injury to the damaged 
extremities. Great care must be exercised to distinguish 



between movements that may endanger the injured 
part and real immobility. The latter, if total and pro- 
longed, can do much harm. Voluntary, careful move- 
ment of the joints at regular intervals is an important 
part of modern treatment. This is done in a whirlpool 
bath in hospitals for maximum effectiveness and safety. 
The patient must not be helped in this activity except 
in the gentle massage or manipulation of the healthy 
muscles and joints outside the actual area of injury. 
Voluntary exercise of this sort is a very important part 
of frostbite treatment. Total immobility can result in 
serious limitation of motion as a final result. 

It now appears as if the best hospital treatment (in 
addition to that discussed above) for all types of frost- 
bite is one or two whirlpool baths daily, each lasting 
for about twenty to thirty minutes, in a water-and-hexa- 
chlorophene solution at body temperature, 37 °C 
(98.6°F). The patient should be urged to flex his 
injured part as much as possible during these treatments, 
but this exercise must not be helped by anyone else 
or by the uninjured hand of the patient himself. 

Throughout the period of convalescence, wherever it 
takes place, the patient is given the best available food, 
maximum comfort and total rest. Healing may be some- 
what accelerated by a high-protein diet, supplemented 
by multiple-vitamin capsules. 

As treatment progresses one should be sure to warn 
the patient well in advance about the dramatic ap- 
pearance that his injured part is soon to have. Even 
a weli-balanced experienced climber can lose his morale 
fast unless he is prepared to accept philosophically 
the blisters, discoloration and grisly necrosis of fingers 
or toes. Furthermore, many an inexperienced doctor 
has been argued into needless and tragic amputation of 
basically sound tissue as a result of the hysterical plead- 
ings of an unreasonable patient with frostbite. 

Surgery is now considered a last resort, to be used 
only if uncontrollable infection is present and then to be 
done only in a hospital. Even minor surgery is to be 
avoided, both in the field and in the hospital. Most 
tissue that seems to demand removal will probably 
remove itself much more effectively than even the best 
surgeon can do it — and with a saving of more tissue 
than may seem at all possible at the time when surgery 
appeared necessary and unavoidable. 

The worst looking hands and feet, if treated properly 
and patiently, will shed their shrivelled black shells 
painlessly like a glove, suddenly and unexpectedly re- 
vealing healthy, pink skin underneath. Patience pays. 

PREVENTION 

Overall physical well-being, good clothing and intel- 
ligent operations in the field are by far the best 
insurance against frostbite. When one is exhausted, 
hungry, ill, injured or hypoxic, one's chances of frost- 
bite injury are increased. A few basic tips for preven- 
tion follow: 



U.S. NAVY MEDICAL NEWS LETTER 



One should dress intelligently to maintain general 
body warmth. In cold, windy weather the face, head 
and neck should be protected adequately. Enormous 
amounts of body heat can be lost through these often 
neglected parts of the body, despite ample protection 
everywhere else. 

One should eat plenty of the right sort of appetizing 
food to produce maximum output of body heat. Diet 
in cold weather at low altitude should tend heavily 
toward fats, with carbohydrates next and proteins least 
important. As altitude increases above 10,000 ft carbo- 
hydrates are most important, and proteins least. One 
should experiment with fats. If members of the party 
digest them readily, they are excellent, but everyone 
should not be expected to like them at high altitude. 

One should not cUmb under too extreme weather 
conditions, particularly at high altitudes on exposed 
terrain, or get too early a start in cold weather. The 
configuration of the mountain can be used to help one 
find maximum shelter and maximum warmth from the 
sun. In short, the climber should use his head — and 
use it more and more the higher he climbs. 

All tight, snug-fitting clothing — particularly on the 
hands and feet — is to be avoided. Socks and boots 
should fit snugly, with no points of tightness. In putting 
on socks and boots, one should carefully eliminate all 
wrinkles in socks. Old, matted insoles are to be avoided. 

Perspiration should be avoided under conditions of 
extreme cold; clothing that ventilates adequately should 
be worn. If one still perspires one should remove some 
clothing or slow down. The feet and hands should 
be kept dry. Even with vapour-barrier boots, socks 
must not be permitted to get too wet. All types of boots 
must be used with great care during periods of in- 
activity, after exercise has resulted in damp socks or 
insoles. 

Mittens should be worn instead of gloves in extreme 
cold, except for specialized work like photography or 
surveying, in which great manual dexterity is required 
for short intervals. In these situations, a mitten should 
be worn on one hand, and a glove temporarily on the 
other, if possible. If bare-finger dexterity is required, 
silk or rayon gloves should be worn, or all metal parts 
that must be touched frequently covered with adhesive 
tape. The thumbs should be removed and fists held in 
the palm of mittens occasionally to regain warmth of 
the whole hand. 

One should always be careful while loading cameras, 
taking pictures or handling stoves and fuel, and re- 
member that the freezing point of gasofine is near 
-57°C (-70°F) and that its rapid rate of evapora- 
tion, as well as its extreme chill, makes it very danger- 
ous. Metal objects should never be touched with bare 
hands in extreme cold — or even in moderate cold when 
the hands are moist. 

Mittens and gloves to be worn in extreme cold 
should always be made of soft, flexible, dry-tanned 



deerskin, moose, elk or caribou — not horsehide which 
dries out very stiff after wetting. Removable mitten 
inners or glove linings should be of soft wool. Oiled 
or greased leather gloves, boots or clothing in cold- 
weather should never be used. Under many conditions 
it is wise to tie mittens together on a string hung around 
the neck or to tie them to the ends of parka sleeves. 

Extra socks, insoles and mittens should always be 
carried in the pack. Socks — at least those worn next 
to the skin — should be kept clean. The use of light, 
smooth, clean socks next to the skin, followed by one 
or two heavier outer pairs, is good practice. 

Constant use of wet socks in any type of boot will 
soften the feet, make the skin more tender, greatly 
lower resistance to cold and simultaneously increase the 
danger of other foot injury such as blistering. 

Toenails and fingernails are kept trimmed to reason- 
able length. 

Hands, face or feet should not be washed too 
thoroughly or too frequently under rough-weather con- 
ditions. Tough, weatherbeaten face and hands, kept 
reasonably clean, resist frostbite most efllectively. 

Wind and high altitude should always be approached 
with respect. Either of them makes otherwise moderate 
conditions more dangerous. Both together can produce 
dramatic results when combined with cold. 

One should not exercise too strenuously in extreme 
cold — particularly at high altitude, where undue exer- 
tion results in panting or very deep breathing. Very 
cold air brought to rapidly into the lungs will chUl the 
whole body, and under extreme conditions may even 
damage lung tissues and cause internal hemorrhage. 

Once a person has been thoroughly chilled (without 
any injury whatever), it takes several hours of warmth 
and rest to return the body to normal, regardless of 
superficial feelings of comfort. When recovering from 
an emergency cold situation, one should not venture 
out again into extreme cold too soon. 

Tobacco or alcohol, even in moderation, should be 
avoided at high altitude — and never used at any altitude 
under conditions when the danger of frostbite is present 
or after it has occurred. 

If one has ever been frostbitten, great care must be 
taken to protect the once injured area from future 
damage. 

Much outdoor work in reaUy cold weather cannot 
possibly be performed in warmth and comfort. One 
must learn carefully how cold one can get while still 
working safely — and then never exceed this limit. 

A person who is frostbitten or otherwise injured in 
the field must keep calm; panic or fear wiU result in 
perspiration, which in turn will evaporate, causing 
further chilling, which will intensify the crisis and 
aggravate the injury itself. 

Tetanus immunity should be kept up to date. It may 
give valuable added protection in the event of frostbite 
or any injury in the field. 



10 



U.S. NAVY MEDICAL NEWS LETTER 



FROM THE NOTE BOOK 



SOUTH POLAR GLACIER NAMED FOR NAVY DOCTOR 
AT OAK KNOLL 



LT Donald R. Walk MC USN, presented a program 
on "The U. S. Navy in the Antarctic" when RADM 
C. L. Andrews and his staff hosted the annual Oak 
Knoll meeting of the Alameda-Contra Costa Medical 
Association meeting on 14 September. 

Doctor Walk, Officer in Charge of Byrd Station, 
during "Operation Deep Freeze — 1960-1961," discussed 
problems of cold weather medicine — snowblindness, 
frostbite, abnormal skin conditions, and emotional 
stresses of living in isolation. He illustrated his talk 
with his own slides and movies. 

Dr. Walk received a commendation from the Com- 
mander in Chief, Atlantic Fleet, for his Antarctic serv- 
ice, and only recently he was informed by the National 
Science Foundation in Washington, D. C, that a glacier 
in the South Polar region has been named for him. 



(Walk Glacier is located in the Jones Mountains, 
Antarctica, at latitude Ti' 38-S and longitude 94° 14' 
West.) 

A graduate of Hahnemann Medical College, Philadel- 
phia, Doctor Walk has been in the Navy for 9 years. 
He is now in residency training in neuropsychiatry at 
Oak Knoll. 

More than 300 East Bay civilian and miUtary doctors 
enjoyed the program and the hickory-smoked prime rib 
roast beef dinner that followed. The annual dinner is 
a tradition dating back to the hospital's early days. 

—From: RADM Cecil L. Andrews MC USN, CO, 
USNH Oakland, California and District Medical Of- 
ficer, 12th Naval District, San Francisco, California. 



IN MEAAORIAM 



RADM Carlton L. Andrus MC USN (Ret) 
RADM Spry O. Claytor DC USN (Ret) 
CAPT O. Henry Alexander MC USN (Ret) 
CAPT Theodore R, Austin MC USN (Ret) 
CAPT Horace R. Boone MC USN (Ret) 
CAPT Max J. Brandt DC USN 
CAPT John F. Foertner MC USN (Ret) 
CAPT Rolland R. Gasser MC USN (Ret) 
CAPT Joseph M. Hanner MC USN 
CAPT Edward A. Hyland DC USN (Ret) 
CAPT Henry A. Imus MSC USNR 
CAPT Stanley Jakubs DC USN 
CAPT Paul F. Leahy DC USNR (Active) 
CAPT Leo W. Olechowski MC USN (Ret) 
CAPT Thomas W. Raison MC USN (Ret) 
CAPT George W. Russell MC USN (Ret) 
CAPT Lewis M. Smylie DC USN (Ret) 
CAPT Louis F. Snyder DC USN (Ret) 
CAPT Robert B. Team MC USN (Ret) 
CAPT Albert J. Zuska MC USN 
CDR Charles H. Fugitt MSC USNR (Active) 
CDR Jonathan E, Henry MC USN (Ret) 



16 September 


1963 


23 August 


1963 


26 September 


1964 


12 September 


1964 


12 August 


1964 


23 February 


1964 


30 April 


1964 


15 August 


1964 


24 January 


1964 


13 July 


1964 


18 May 


1964 


29 January 


1964 


23 September 


1964 


15 March 


1964 


20 February 


1964 


5 June 


1964 


13 March 


1964 


24 April 


1964 


9 July 


1964 


19 July 


1964 


23 March 


1964 


15 June 


1964 



U.S. NAVY MEDICAL NEWS LETTER 



11 



CDR Francis R. Hittinger DC USN (Ret) 

LCDR Eleanor M. Brady NC USN 

LCDR John D. Foley MC USN (Ret) 

LCDR Emma Laurie Gamble NC USNR (Ret) 

LCDR William E. Kelly MSC USN (Ret) 

LCDR John O. LaBrie MSC USN (Ret) 

LCDR Pearl Picard NC USN (Ret) 

LCDR Mary Prescott NC USN 

LT Walter L. Bach MC USN (Ret) 

LT Ben H. Bledsoe MSC USN (Ret) 

LT Bruce C. Farrell MC USNR (Active) 

LT Arnold J. Goldstein MC USNR (Active) 

LT George E. Harris MSC USN (Ret) 

LT Bride C. Lauer NC USNR (Active) 

LT William J. Lowell MSC USN (Ret) 

LT Charles R. Moberly MC USNR (Active) 

LT George I. Vliet MSC USN (Ret) 

LTJG Mary H. McGrath NC USNR (Active) 

Chief Nurse Ada Chew NC USN (Ret) 

CMSW Charles A. Barnes USN 

CMSW George M. Stacy USN (Ret) 

MSW Norman J. Seamster USN (Ret) 



1 September 


1964 


21 Novemebr 


1963 


9 August 


1964 


22 June 


1964 


30 November 


1963 


30 March 


1964 


20 March 


1964 


25 October 


1963 


5 August 


1964 


31 March 


1964 


8 October 


1963 


19 July 


1964 


26 February 


1964 


23 January 


1964 


3 April 


1964 


8 March 


1964 


13 May 


1964 


19 June 


1964 


23 April 


1964 


17 May 


1964 


13 October 


1963 


10 November 


1963 




DENTAL SECTION 



THE USE OF LOCAL ANESTHESIA IN THE 
PRESENCE OF INFLAMMATION 

Mehyn H. Harris, DMD, Oral Surg., Oral Med. & 
Oral Path. 18(!}: 16-23, July 1964. 

The author cites many instances in which local 
anesthetic agents have been used properly, with signs of 
excellent anesthesia obtained, yet the dentist has found 
the anesthesia inadequate at the operative site. He 
cites inflammation (acute and subacute) as the common 
denominator in such instances. He compares this ob- 
servation with other sites of the body such as healthy 
viscera or cranial bone which are normally insensitive, 
such as to instrumentation, but which become painful 
when acutely inflamed. 

He points out that the mechanisms and pathways of 
such pain are not yet completely understood and de- 
scribes two observations which are suggestive. The 



first is that distention of many blood vessels will elicit 
pain. Second, many blood vessels have been shown to 
be well supplied with nerve fibers, both myelinated and 
unmyelinated. He cites recent research reports to the 
effect that unmyelinated fibers (previously considered 
only vasomotor) are now known to be pain conducting. 
There has also been a recent demonstration of peri- 
capillary unmyelinated nerve fibers and branching 
varicose terminals which appeared similar to free- 
branching "pain" receptors. Additionally, the author 
cites studies of pain producing substance isolated from 
inflammatory exudates, which apparently sensitizes pain 
nerve endings. On these premises he explains that, in 
cases of dental pathology, the presence of inflammatory 
exudates and vascular distention provides a mechanism 
for intractable pain; and the local anesthetic is efifective 
only on the sensory nerve innervation. 



12 



U.S. NAVY MEDICAL NEWS LETTER 



The author supports this concept with his observation 
that local anesthetics containing a vasoconstrictor in- 
jected directly into the inflamed area are quite effective. 
He further supports the concept with histological evi- 
dence of unmyelinated nerve fibers associated with 
capillaries in tissues from a radiolucent periapical area. 

The present concepts of the inadequateness of local 
anesthetics when injected into inflamed tissue are ques- 
tioned. The two principles, distention of blood vessels 
causing vascular pain and perivascular nerve libers 
conducting painful nerve impulses are currently under 
investigation. If they prove to be true, injection directly 
into the inflamed tissue might obtain adequate local 
anesthesia. Whether this would be due to the effect of 
the vasoconstrictor or the pressure of the fluid injected 
into a confined area remains to be determined. 



INDICATIONS AND CONTRAINDICATIONS 
FOR ENDODONTIC SURGERY 



Raymond G. Luebke. DDS., Dudley H. Click, DDS., 

and John L Ingle, DDS-MSD, Oral Surg., Oral Med. 

& Oral Path. 18(1): 97-113, July 1964. 

Endodontic surgery, in combination with root canal 
therapy, has become a remarkably successful method 
for the elimination of certain periapical pathoses. As 
with all successful methods, part of its success is due 
to its simplicity, and therein lie the seeds of its abuse. 

The surgical approach to endodontics has been badly 
misused. In some practices the treatment of every pulp- 
less tooth is followed by periapical surgery. Further- 
more, this narrow perspective toward saving the pulpless 
tooth is generaUy limited to the anterior teeth, thereby 
demonstrating a lack of skill and a lack of appreciation 
for the whole month concept of dental practice. 
Endodontic therapy, including every form of endodontic 
surgery, is applicable to all areas of the dentition, 
posterior and anterior alike. 

Recent improvements in materials and methods have 
made nonsurgical endodontic therapy the treatment of 
choice in almost all cases of pulpal and periapical dis- 
ease. The mistaken conviction that every periapical 
lesion requires surgical treatment is common. Equally 
prevalent and irrational is the notion that "smaU" lesions 
may be treated by nonsurgical means, whereas "large" 
ones must be managed surgically. 

The case for nonsurgical endodontic procedures is 
strengthened by the patient's reaction. The anxious and 
fearful anticipation of surgical procedures which is 
common to most patients and the ever-present possibility 
of postoperative pain and swelling should act as a 
deterrent to promiscuous surgical intervention. From 



this discussion, one might get the impression that the 
surgical approach need never be used. Such is not 
the case, for there are definite circumstances in which 
it is required as an adjunct to conventional therapy. 
These indications and contraindications to surgery have 
not been previously spelled out in detail. 

Indications for Endodontic Surgery 

A. Necessity for drainage 

1. Elimination of toxic material 

2, Alleviation of pain 

B. Postoperative failure of conventional therapy 

1 . Obvious inadequate filling 

2. Apparently adequate filling 

3. Persistent postoperative discomfort 

C. Predictable failure with conventional therapy 
1. Flaring apex 

Severely curved root end 

Internal, external, or apical resorption 

Fractures in the apical third 

Persistent infection 

Persistent suppuration or exudation 

Forecast of acute abscess 

Apical cyst 

D. Impracticality of conventional therapy 

1. Porcelain jacket crown 

2. Fixed partial denture attachment 

3. Dowel-retention crown 

4. Excessive calcification 

5. Associated periodontal lesion 

E. Procedual accidents 

1. Instrument fragmentation 

2. Perforation 

3. Overinstrumentation 

4. Gross overfiUing 

Each of these indications and several contraindica- 
tions are explained in the original article and merit com- 
plete review and study. Among the contraindications 
discussed are the health factors and anatomic factors. 
The dental profession has experienced considerable 
difficulty in finding within its procedures a suitable 
niche for surgical endodontic therapy. At one extreme, 
this type of treatment has been overused and abused. 
With the excellent results attributable to conventional 
treatment methods, one can hardly justify surgical 
treatment of every anterior pulpless tooth on any basis 
other than economics or expedience. Conversely, only 
insecurity or inability can explain the fact that in some 
practices surgical endodontic therapy is never employed. 
Common sense, sound clinical judgment, and an under- 
standing of the principles described here provide the 
basis for a broad and workable rationale for periapical 
surgery. 



U.S, NAVY MEDICAL NEWS LETTER 



13 



CORRELATION BETWEEN PLAQUE 
AND GINGIVITIS 

M. M. Ash, Jr. DDS-MS, B. N. Gitlin and W. A. Smith 
DDS-MS. J. Periondont. 35(5): 581424-62/428 Sep- 
tember-October 1964. 

A study of the correlation between plaque and gingi- 
vitis before and after prophylaxis was carried out on 
78 patients who had reasonably good oral hygiene. 
Plaque and gingivitis scores were obtained prior to 
prophylaxis (0 days), and at 5-7, 30, and 60 days fol- 
lowing prophylaxis. The results of the study indicate 
that there is a high positive correlation between the 
degree of plaque and the degree of gingivitis present. 



MOUTH PROTECTORS GUARD TEETH 
DURING ANESTHESIA 

More anesthesiologists are using mouth protectors 
to prevent injuries to the patient's upper anterior teeth 
and to dental prostheses during general anesthesia when 
orotracheal or nasotracheal intubation is indicated, a 
dental scientist reports. Damage may occur under such 
circumstances because the incisal edges of the upper 
anterior teeth commonly are used as a fulcrum for the 
laryngoscope to expose the larynx before intubation, 
according to Dr. Samson Flores of the College of 
Dentistry, University of Illinois. 

The traumatic insertion of an oropharyngeal airway 
may damage the anterior teeth, Dr. Flores noted in 
September Dental Abstracts, published by the American 
Dental Association. 

Month protectors are also indicated during insertion 
of an airway when; 

— The patient has a fixed partial denture, especially 
one with fixed porcelain facings in the upper anterior 
region. 

— The patient has a single-unit maxillary porcelain or 
acrylic jacket crown and a sudden blow by an instru- 
ment such as the laryngoscope may fracture the tooth. 
— The patient has anterior teeth with nonvital pulps 
and has undergone root canal therapy, with large silicate 
restorations in the anterior teeth. 

— The upper teeth are periodontaliy involved and 
weakened by bone loss. 
— The patient is between 5 and 10 years old. 
— Class III or Class IV restorations which may weaken 
the incisal edges of the teeth are present. 
— A mouth protector can provide a more stable fulcrum 
point for the laryngoscope in edentulous patients. 

The original article appeared in the June-July 1964 
issue of the Journal of the American Dental Society of 
Anesthesiology. 



PATIENT REACTION TO DENTURE 
ESTHETICS 

Lester E. Rosenthal, DDS, Max A. Pleasure, DDS- 
MSPH, and Leon Lefer, MD-DDS-MPH. J Den Med 
19(3): 103-109, July 1964. 

Dentist-patient interaction, resulting in negative feel- 
ings on the part of the patient, may through the mecha- 
nism of displacement result in dissatisfaction with com- 
pleted dentures. One example of this interaction is the 
passive patient-authoritarian dentist relationship. The 
dentist who considers only his own feelings about what 
looks best in the patient's mouth may be disappointed 
by the patient's lack of acceptance of the completed 
dentures. An important factor that must be considered 
is the need in the patient to maintain his body image, 
as it was prior to the extraction of all his teeth. A 
method was developed and tested which required the 
dentist to be passive and the patient to do all the choos- 
ing of denture esthetics from color photographs. When 
the patient's choice was compared to choices made by 
a psychiatrist and a prosthodontist, little predictability 
was found. It is believed that the patient fulfills un- 
defined psychological needs and restores his body image 
by having free choice of all denture esthetics. The results 
indicated an increase of patient satisfaction and a de- 
crease in the number of adjustments to the dentures 
following their insertion. The choice of denture 
esthetics revolved between aggressive looking, passive 
looking, conformist-textbook style and beauty-contest 
girl esthetics. Personality profiles could not be con- 
structed for individuals who chose particular setups. 
It was found that the greatest degree of satisfaction in 
the control group of patients (who were treated as 
their dentists usually treated patients) occurred when 
the dentist considered the patient's feelings as his most 
important guide in selecting denture esthetics. 



PERSONNEL AND PROFESSIONAL 
NOTES 



U.S. NAVAL STATION TREASURE ISLAND 
HOSTS DENTAL STUDY GROUP 

The Dental Department, U, S. Naval Station, San 
Francisco, California, hosted a meeting of 115 members 
of the Bay Area Armed Forces Dental Study Group 
on 15 September 1964. Preceding the meeting. Captain 
James J. Dempsey, DC USN, Twelfth Naval District 
Dental Ofiicer, who served as program chairman, led 
a group of Naval dental officers for chapel services 
in honor of the late Captaui Arne Nielson DC, USN 
(Ret). 



14 



U.S. NAVY MEDICAL NEWS LETTER 



Guest speaker for the occasion was Captain Benjamin 
W. Oesterling DC, USN (Ret), Professor of Prostho- 
dontics, Loma Linda University, Loma Linda, Cali- 
fornia. His lecture "Partial Dentures," illustrated with 
color slides, presented practical methods for handling 
various types of prosthetic patient problems that are 
apt to confront the dental officer ashore, afloat, or on 
isolated duty. 

Originally organized as a prosthetic study group, 
interest has broadened the scope of the Bay Area 
Armed Forces Dental Study Group to include all phases 
of dentistry. Regular participation by dental officers 
of the Army, Air Force, Navy, Coast Guard and the 
Public Health Service has brought about a most bene- 
ficial exchange of ideas and has fostered excellent 
interservice relations. 



REQUESTS DESIRED FOR ASSIGNMENT TO 
DENTAL TECHNICIAN SCHOOLS 

Requests for assignment to Prosthetic (Basic); Gen- 
eral, Advanced; and Prosthetic, Advanced Dental Tech- 
nician Schools are desired from eligible personnel. Since 
assignment to these schools is normally granted only 
upon rotation, in accordance with Seavey, Shorvey and 
Wavevey procedures, eligibility lists are becoming de- 
pleted. 

Responsible dental officers are requested to dissemi- 
nate this information to all qualified Dental Technicians 



who are eligible for rotation. Requests shall be in 
conformance with BUMEDINST 1510.2D. 

CAPTAIN ARMSTRONG PRESENTS CLINIC 
AT QUANTICO 

CAPT Lloyd M. Armstrong, DC, USN, U. S. Naval 
Dental School, National Naval Medical Center, 
Bethesda, Maryland, presented a projected clinic entitled 
Effective Utilization of Modern Operative Techniques 
before the Dental Detachment, Marine Corps Schools, 
Quantico, Virginia, on 24 September 1964. 

U.S. NAVAL DENTAL CORPS RETIREMENTS 

The following dental officers retired during the first 
quarter of Fiscal Year 1965: 

CAPT Jack J. Kelly, DC USN 
CAPT GUbert H. Larsen, DC USN 
CAPT Kenmore E. Merriam, DC, USN 
CAPT Lloyd A. Bbhaker, DC USN 
CAPT Carl A. Veline, DC USN 
CAPT William H. Key, DC USN 
CAPT Clarence Y. Murff, DC USN 
CAPT George W. Parr, DC USN 
CAPT William R. Franklin, DC USN 
CAPT Davis Henderson, DC USN 
CAPT William B. Johnson, DC USN 
CAPT William I. Gullett, DC USN 
CDR Melvin L. Hermsmeyer, DC USN 



LIST OF NEWLY STANDARDIZED ITEMS AVAILABLE FOR ISSUE 



NOMENCLATURE 

Plugger, Plastic Filling, Dental, Gregg No. 1 

Wax, Dental, Bite, Metal Impregnated, 1 lb 

Band, Matrix, Dental Tofflemire, Contour, Preformed, 24's 

Bur, Denture Trimming, Steel, 6's 

Band, Matrix, Dental, Tofflemire, No. 3, 12's 

Band, Matrix, Dental, Tofflemire, No. 1, 12's 

Band, Matrix, Dental, Tofflemire, No. 2, 12's. 

Point Assortment, Pulp Canal, Silver, 90's 

Grinding and Polishing Machine, Dental Laboratory, 

Bench Mounted, High Speed 110 Volt, 60 Cycle, AC 

Forceps Tooth Extracting, No. 88R 

Forceps Tooth Extracting, No. SSL 

Forceps, Articulating Paper, Dental, 6 Inch 

Ultrasonic Prophylaxis Unit, Dental 

Handpiece, Angle, Dental Prophylaxis 

* Sterilizer, Surgical Instrument, Dry Heat Type, 

Electrically Heated, CRM, 1 IVi x 6i/4 x 5 inches, 

I lOv., 60 cy, AC 

♦"Policy on Sterilization," U.S. Navy Medical News Letter 44(1): 22-26, 3 July 1964. 



FSN 

6520-066-1117 
6520-066-6705 
6520-070-7518 
6520-076-8684 
6520-721--9351 
6520-721-9355 
6520-721-9356 
6520-889-6649 
6520-889-7497 

6520-955-1 S36 
6520-955-1837 
6520-890-1724 
6520-890-1584 
6520-982-8308 
6530-962-9965 



UNIT 


UNIT 


ISSUE 


PRICE 


EA 


.95 


BX 


L40 


P& 


1.00 


PG 


3.70 


PG 


.14 


PG 


.14 


PG 


.14 


PG 


4.50 


EA 


171.00 


EA 


6.30 


EA 


6.30 


EA 


1.70 


EA 


652.00 


EA 


12.05 



EA 



76.00 



U.S. NAVY MEDICAL NEWS LETTER 



15 




PREVENTIVE MEDICINE 



COMMISSION ON MALARIA OF THE ARMED FORCES 
EPIDEMIOLOGICAL BOARD 



Doctor Gustave Dammin, President of the Armed 
Forces Epidemiological Board, announced the forma- 
tion by the Board of a Commission on Malaria to 
cope with problems related to the prevention, treatment 
and control of the disease and the rise in health hazards 
from malaria infection. The Commission, the 1 4th to 
serve the Department of Defense through the Armed 
Forces Epidemiological Board, succeeds the Board's 
Committee on Malaria. 

Doctor L. H. Schmidt, Professor of Comparative 
Pharmacology at the University of California, will serve 
as Director of the Commission, Other members of the 
Commission will be: Doctor G. Robert Coatney, Lab- 
oratory of Parasite Chemotherapy, National Institutes 
of Health, U.S. Public Health Service, Department of 
HEW; Doctor Robert C. Elderfield, Professor of 
Chemistry, University of Michigan; Doctor Clay G. 



Huff, Department of Parasitology, U.S. Naval Medical 
Research Institute, National Naval Medical Center, 
Bethesda; Doctor Harry Most, Chairman, Department 
of Preventive Medicine, New York University School of 
Medicine; Doctor Robin D. Powell, Professor of Medi- 
cine, University of Chicago; Doctor Lloyd E. Roze- 
boom. Professor of Entomology, Johns Hopkins 
University School of Hygiene and Public Health; Doc- 
tor Leslie A. Stauber, Professor of Zoology, Rutgers 
State University; Colonel William D. Tigertt MC USA, 
Director of Walter Reed Army Institute of Research; 
Doctor William Trager of the Rockefeller Institute 
and Doctor Thomas H. Weller, Richard Pearson Strong, 
Professor of Tropical Public Health, Harvard School 
of Public Health. 

The first meeting was scheduled for 2-3 October 
1964 at the Walter Reed Army Medical Center, Walter 
Reed Army Institute of Research, Washington, D. C. 



HOMES FOR AGED IN SWEDEN 

In Sweden, special designs for homes for the aged, developed by Swedish architects in a national competition, 
provide for division of even the largest home into small units in which six or seven residents share a living room, 
family-sized dining room, and small kitchen for making coffee and between-meal snacks. Private sleeping and 
toilet rooms adjoin these common facilities. The casual and informal atmosphere of the architecture is carried 
over into management of the homes, where there are no rules, regulations, or specified hours for visiting or other 
activities and no segregation by sexes. The directors (an increasing number of homes are managed by women with 
3 years of special training) encourage residents to be as independent as possible. Fees charged by the homes are 
low enough so that, through pensions and other income sources, all elderly people can afford them. — Public Health 
Reports 78(11): 1009, November 1963. 



16 



U.S. NAVY MEDICAL NEWS LETTER 



Fetal Life Study 



BRIEFS, Published by Maternity Center Association, 48 East 92nd St., New York 
28, N. Y. Fetal Life Study, 27(10): 158-160, Dec. 1963. Republished in U. S. Navy 
Medical News Letter by permission of Mr. Horace H. Hughen, Editor of BRIEFS. 



Since an epidemic of German measles swept Australia 
in 1940, physicians have known that women who con- 
tract the disease during pregnancy often give birth to a 
deformed baby. For 20 years after that, however, the 
actual probabilities of deformity in such cases re- 
mained a mystery. 

In 1960 the Columbia-Presbyterian Medical Center's 
Fetal Life Study, which has been accumulating data on 
expectant mothers and their offspring since 1946, pro- 
duced tables that resulted in greater understanding of 
the problem. 

The tables, based on a review of available literature 
and data obtained from 25 cases in the study, indicated 
that the probability of a deformity in a liveborn child 
was 47 in 100 if German measles occurred in the first 
month of pregnancy, 22 in 1 00 if it occurred during the 
second month, dropping sharply to 7 in 100 the third 
month and 6 in 100 during the fourth. After this, the 
tables indicated, the incidence was no higher than that 
in the general population. 

The Fetal Life Study has amassed and sorted clinical 
data on more than 15,000 pregnancies, % of them fol- 
lowed from the prenatal stage until a year after birth. 

During the spring of 1947 a smallpox scare hit New 
York City. Many physicians, fearing possible ill effects 
upon unborn babies, hesitated recommending vaccina- 
tions for their pregnant patients. 

During the mass smallpox vaccination that ensued, 
however, the Fetal Life Study collected evidence based 
on almost 900 cases that indicated vaccination during 
pregnancy does not increase the incidence of congenital 
malformations, stillbirths, abortions or infant mortality. 
This Study has furnished the grist for many other 
medical reports, but so extensive is the hoard of infor- 
mation gleaned over the years that much of it remains 
to be interpreted. 

The Study Director believes that the data already 
available, once they are analyzed, will furnish statis- 



tics enabling physicians to better predict a woman's 
chances of bearing a normal, healthy baby. 

The Fetal Life Study was one of the first endeavors 
in this field to gather information directly through 
observation and questioning of the patient, rather than 
through secondhand reports. 

Original tabulations and analyses were made by hand, 
but as the volume of data increased, mechanical tabu- 
lation became a necessity. IBM cards came into use 
in 1955, bringing added speed and efficiency to the 
work of data storage and analysis, but they too are 
proving inadequate to the huge task, and the Study 
Director and associates are now exploring the ad- 
vantages of magnetic tape. 

By feeding the machines data already collected, the 
Study Director and associates hope to focus new light 
on areas where medical knowledge remains cloaked in 
lingering shadows, specifically, to determine effects on 
the baby, if any, of colds or similar infections that 
attack a mother during pregnancy, and effects due to 
mother's smoking habits and travel experiences. Plans 
to study the effect of the mother's age, weight and 
previous pregnancy history in relation to the present 
pregnancy are being developed. 

The Study Director believes once the computers are 
regularly analyzing new information as it is gathered, 
the study will work as an early warning system that 
will alert them to new trends in birth defects. 

Such rapid analysis of data would furnish clues to 
dangers in time to prevent widespread tragedy, such 
as that occasioned recently by the drug thalidomide. 

In the past, the alert clinician has been the most 
sensitive warning system. Such was the case with both 
thalidomide and German measles. But a large, con- 
tinuing clinical study, such as the Fetal Life Study, 
gathers in a relatively short time, with the aid of com- 
puter analysis, certain clinical information which no 
one clinician could experience in a lifetime. 



MORE LIVES COULD BE SAVED 

About 90,000 men, women and children will die in 
the United States this year of cancer unnecessarily, the 



American Cancer Society has estimated. These lives 
could have been saved with earlier detection and 
prompt, proper treatment of the disease. 



U.S. NAVY MEDICAL NEWS LETTER 



17 



You Can Prevent Foodborne Illness 



PHS Pub No. 1105, November 1963 (A copy may be obtained from Superintendent 
of Documents, U.S. Government Printing Office, Washington, D. C. 20402, Price 
5 cents; $2.50 per 100). 



Foodborne Illness — A Major Public Health Problem. 
An estimated one million or more persons in the 
United States are affected each year by foodborne ill- 
ness (food poisoning). 

Why Do These Illnesses Occur? 

Food poisoning occurs when individuals who prepare 
and serve food fail to apply known food protection 
measures. 

What Causes Food Poisoning? 

Foodborne illnesses may occur after eating: food 
containing disease-producing bacteria (so-called germs), 
food containing poisons (toxins) produced by harmful 
bacteria, food containing parasites which can infect 
man (such as worms in meat), food which is contami- 
nated, either accidently or carelessly, with harmful 
chemicals, or food which is naturally poisonous (such 
as some mushrooms). 

Foodborne Illness Can Be Prevented! 

First, prevention starts with the food. A good safe 
food product must be used, one that is protected from 
contamination from producer to user. (Inferior, un- 
safe food cannot be magically transformed into a safe, 
premium product.) Then correct preparation, storage, 
and refrigeration procedures must be followed. 

Second, all food service workers should practice 
good personal hygiene. They should wash their hands 
thoroughly and often. They should not work if ill; if 
they have a bad cold; or have an infected cut or burn 
on the hands. A person's hands and spray from his 
coughs and sneezes all contain literally millions of 
germs that can thrive on foods if the right time and 
temperature, and conditions of moisture exist. 

Third, food preparation and serving techniques must 
be correct. Food should never be touched by the hands 
of a food service worker whenever a clean sanitized 
utensil can be used instead. Potentially hazardous foods, 
which include those most frequently involved in food- 
borne disease outbreaks (meat, eggs, milk, cream pies, 
etc.) should be stored at temperatures below 45° F. 
(BUMED recommends 40° F.) or above 140° F. at 
all times except during actual preparation or service. 
Dishwashing procedures must also be effective. A "slip- 



up" in one of these phases of food preparation and 
service can undo all other efforts to provide protection. 
Food service establishment operators find that it is 
good business to protect their patrons, and incidentally 
themselves, from food poisoning. 



CASE STUDIES 

If a person who prepares and serves food asks "Can 
I be the cause of a food poisoning outbreak?" the an- 
swer is "yes" whether the person asking the question 
is a chef, waitress, dishwashing machine operator, home- 
owner or other person who handles food or food 
equipment. 

The following examples are but a few of thousands of 
recently reported cases where it did happen. The cases 
are summarized, and prevention methods are then 
given. 

CASE I. — Seventeen persons aboard a ship became 
ill within 8 hours after eating a noon meal. Nausea, 
vomiting, cramps, and diarrhea were the symptoms. 
Macaroni had been cooked prior to the meal, and 
chopped pimentos, lettuce, boiled eggs, mayonnaise 
and mustard were hand-mixed by two mess cooks. One 
of those cooks had several minor cuts on two fingers. 
These finger cuts yielded Staphylococcus aureus, the 
same kind of bacteria found in the salad. 

PREVENTION. — Never use your hands to mix foods 
when clean sanitized utensils can be used! Never work 
with food when you have infected cuts because the 
germs causing the infection may be a source of food- 
borne illness! 

CASE 2. — Following the drinking of punch served 
in a coffee shop, 14 of 25 persons drinking the beverage 
became ill with cramps and diarrhea. The punch had 
been prepared in a galvanized iron container, then 
stored in a refrigerator. Upon investigation, it was 
shown that the container, although new, had been cor- 
roded by the action of the acid in the punch. Chemical 
analysis of the remaining punch showed that a consider- 
able amount of zinc had been dissolved from the con- 
tainer lining. 



18 



U.S. NAVY MEDICAL NEWS LETTER 



PREVENTION. — Never use utensils containing toxic 
materials in the preparation and storage of foods. 
Food containers made with metals such as antimony, 
zinc, cadmium and lead have been sources of foodborne 
illnesses. All containers used for storing, transporting, 
preparing and serving of food should be made of 
smooth, easily cleanable, nontoxic materials, 

CASE 3. — Approximately one hour after supper, 
four persons vomited, became nauseated, dizzy, and 
had difficulty in swallowing, talking and seeing. During 
supper they had eaten what they thought were coUard 
greens. Actually, these "greens" were the leaves of a 
wild tobacco plant. 

PREVENTION. — Always be certain that you know 
any foods you pick for yourself. Some plants may look 
alike, yet actually be quite different, 

CASE 4. — Two persons became ill about 15 minutes 
after eating mushrooms. Symptoms included nausea, 
dizziness, numbness, and vomiting. The mushrooms 
had been picked fresh, refrigerated, peeled, cleaned, 
boiled, and fried. Examination of similar types of 
mushrooms showed that these were poisonous. 

PREVENTION. — Never pick mushrooms unless you 
know the difference between nonpoisonous and poison- 
ous varieties. In most cases, only an expert can tell 
the difference. 

CASE 5. — Sixteen persons experienced acute upset 
stomachs within 5 hours after their evening meal. Egg 
salad was the food suspected. The eggs were boiled 
and shelled early that afternoon. One of the cooks then 
added mayonnaise and relish to the chopped eggs. 
After preparation, the salad was not refrigerated. The 
cook who prepared the salad had tonsillitis. 

PREVENTION. — Food service workers should not 
work when they are ill. Potentially hazardous (readily 
perishable) foods should be refrigerated at temperatures 
of 45° F. (BUMED recommends 40'* F.) or below, 
or kept at 140° F. or above until serving. 

CASE 6. — One hundred and fifty-live persons became 
ill with severe diarrhea and stomach pains. The sus- 
pect meal, roast beef and gravy, had been eaten by 
170 persons. This beef and gravy had been prepared 
the day before and allowed to cool in open trays without 
refrigeration for 22 hours. Clostridium perfringens 
organisms were found in the beef and gravy. 

PREVENTION. — Potentially hazardous {readily 
jterishable) foods should be thoroughly cooked and 
then either kept hot (140° F. or above), or cold (re- 
frigerated to 45° F. (BUMED recommends 40° F.) 
or below) until serving time. 

CASE 7. — At a church dinner, over half of those 
who had eaten barbecued chicken became ill within 6 
hours. The chickens had been cooked the day before. 



immediately refrigerated overnight, then reheated the 
next morning. After reheating, they were cut into 
quarters with the butcher's meat saw. The chickens 
were without refrigeration from 10:00 a.m. until being 
reheated again around 5:00 p.m. Large numbers of 
Staphylococci were recovered from the chickens. These 
bacteria could have come from the meat saw or from 
the cook's hands which contained numerous small cuts 
and abrasions. 

PREVENTION. — Food service workers should never 
use a utensil or work surface in food preparation unless 
it has been cleaned and sanitized. The worker should 
not work with food if he has open infected cuts or 
abrasions. As an added precaution, potentially hazard- 
ous (readily perishable) foods should be kept hot 
(140° F. or above) or cold (45° F. (BUMED recom- 
mends 40° F.) or below) except when being prepared 
or served. 

CASE 8. — Eleven cases of trichinosis occurred in a 
small community among seven families who had eaten 
raw smoked sausage prepared from the same hog. 
Symptoms were high fever, muscle pain, stomach 
cramps, chiUs, and general weakness. This illness 
was caused by Trichinella spiralis, a small parasite pres- 
ent in the uncooked pork. 

PREVENTION. — Pork should never be eaten unless 
it has been thoroughly cooked. All pork, unless other- 
wise treated to destroy trichina should be cooked suf- 
ficiently to reach an internal temperature at least 150° 
F. This destroys the parasite. (Use a cooking thermo- 
meter. ) 

CASE 9. — Four cases of botulism, including one 
death, occurred as a result of the consumption of home- 
canned chili. Symptoms were vomiting, dizziness, dif- 
ficulty in breathing and speaking, and blurring of vision. 
There was paralysis for a time. The chili had been 
home-canned under insufficient temperature and pres- 
sure. This permitted a toxin to be formed in the chili. 

PREVENTION. — ^A pressure cooker should he used 
to can all meats or low-acid foods. The high tempera- 
ture and pressure used will destroy the spores which 
produce toxin. Foods which contain the toxin often 
smell no different than safe foods, but even a taste, if 
the toxin is present, may be sufficient to cause illness 
and death. Commercially canned foods are safe to use 
since temperatures and pressures used in their prepara- 
tion are high enough to destory the bacterial spores. 

It's Up To You! 

As can be seen from the cases described, foodborne 
illnesses can happen if safe food service rules are not 
followed. Good, safe food service practices will help 
you to prevent foodborne illness. 



Male circumcision has been shown to be completely effective in preventing cancer of the penis, and probably also 
helps prevent cancer of the uterine cervix in the female partner. — WHO Chronicle 18(9): 325, September 1964. 



VS. NAVY MEDICAL NEWS LETTER 



19 



Public Health Regulations for the Importation or Reentry 
of Pets into the United States 



USDHEfV, PHS, Identical Memorandum, DFQ.IO, to Editors of Pet Magazines and 
Others Concerned with the Facilitation of International Travel, 6 Aug 1964. 



Editorial Note 

General Order No. 20, Department of the Navy, 
Washington, D. C, 12 May 1962, incorporates infor- 
mation on importation of psittacine birds, dogs, cats, 
or monkeys. Additional information regarding Federal 
regulations may be obtained from: Chief, Bureau of 
Medicine and Surgery (Code 72), Department of the 
Navy, Washington, D. C; the nearest Public Health 
Service Quarantine Station in the United States; or 
offices of the U. S. Department of State in various 
countries. Information regarding State and local regu- 
lations should be obtained from the State and local 
health departments in the State of first arrival and desti- 
nation. Information regarding regulations of other 
countries should be obtained from the health depart- 
ments of the countries involved or from their repre- 
sentative offices in the United States. — Director, Pre- 
ventive Medicine Div., BuMed. 

SUMMARY OF PUBLIC HEALTH SERVICE 
REGULATIONS 

7LI52. Psittacine birds. Psittacine birds (parrots, 
parakeets, lovebirds, macaws and others of the order 
Psittaciformes) shall not be brought into the United 
States, its Territories, or possessions for purpose of 
sale or trade. Psittacine birds may be brought in under 
certain conditions (specified in the regulations) for 
medical research or zoological parks; pet birds may be 
imported as follows; 

(3) Pets. 

(i) A maximum of 2 psittacine birds may be im- 
ported by the owner thereof provided (a) the birds 
appear to the quarantine officer to be ia good health; 
(b) they are not intended for sale or trade in the United 
States; (c) not more than 2 birds are brought in by 
members of a family comprising a single household; (d) 
neither the owner nor any member of his family within 
his household has imported any other birds under this 
paragraph in the preceding 12 months; and (e) the 
birds have been in the owner's possession and pers<mal 



custody for the 4 months preceding arrival, except for 
any period occasioned by arrival of the owner and birds 
on separate conveyances or as provided in subdivision 
(ii) of this subparagraph. 

(ii) A maximum of 2 psittacine birds that have 
been in the owner's possession and personal custody 
immediately before arrival, but for less than 4 months, 
may be admitted provided (a) other requirements of 
subdivision (i) of this subparagraph are met and (b) 
upon admission, for a period beginning with their 
arrival and ending 4 months after they first came into 
the owner's possession and personal custody the birds 
are confined in detention facilities, either at the port of 
arrival or elsewhere, at the owner's expense and under 
such arrangements approved by the quarantine officer 
at the port of arrival as will reasonably assure against 
transmission of psittacosis. If the owner does not make 
the necessary detention arrangements before arrival of 
the birds, they may be excluded unless he arranges for 
such detention immediately upon their arrival. 

(4) Return to the United States. 

Psittacine birds taken out of the United States may 
be admitted upon their return if either of the following 
conditions is met: 

(i) Without a permit. The birds may be admitted 
without a permit upon their return on one or more 
occasions, if the requirements of subparagraph (3) of 
this paragraph are complied with on each occasion. 

(ii) With a permit. If the requirements of subpara- 
graph (3) of this paragraph are not fully complied 
with, they may be admitted provided (a) they are ac- 
companied by a permit for return issued by the Sur- 
geon General, (b) the owner submits a statement 
certifying his compliance with the terms of the permit 
and such other information as the Surgeon General 
may require, and (c) the birds appear to the quarantine 
officer to be in good health. Application for such a 
permit may be denied unless the owner of the birds 
applies for such permit prior to 'their departure from 
the United States and the application includes a state- 



20 



U.S. NAVY MEDICAL NEWS LETTER 



tnent as to the itinerary, the number and description 
of the birds, and such other information as the Surgeon 
General may require. 

71.154. Dogs, Cats, and Monkeys (Summary). 

1. General Inspection Requirements. All domestic 
and wild members of the dog, cat, and monkey (pri- 
mate) families brought into the United States from any 
foreign country shall be inspected at the port of arrival 
for evidence of communicable disease. When such an 
animal does not appear to be in good health on arrival 
(i.e., it has such symptoms as emaciation, lesions of 
the skin, nervous system disturbances, jaundice, or 
diarrhea), the medical officer in charge may give the 
owner or his agent an opportunity to call in a licensed 
veterinarian to examine it and give or arrange for any 
tests or treatment indicated, at the owner's expense. 

Only animals in which no evidence of disease com- 
municable to man is revealed shall be admitted. If 
necessary to detain the animal pending determination 
of its admissibility, the owner or agent shall provide 
satisfactory detention facilities. 

2. Dogs Only; Rabies Vaccination. Vaccination for 
prevention of rabies is required for dogs brought into 
the United States, with certain exceptions for wild 
members of the dog family; dogs coming from rabies- 
free countries; dogs destined to zoological parks or 
for research; and puppies under three months of age. 
(The regulations must be consulted for details of these 
exceptions and conditions under which they are made. 



Where rabies vaccination is requu-ed, the dog shall 
be accompanied by a valid certificate of such vaccina- 
tion identifying the dog, signed by a licensed veteri- 
narian, and specifying that such veterinarian vaccinated 
the dog with "nervous-tissue" or "chicken-embryo" 
vaccine, on a stated date. Vaccination must be ac- 
complished with nervous-tissue vaccine more than one 
month but not more than 12 months before the dog's 
arrival, or with chicken-embryo vaccine more than one 
month but not more than 36 months before arrival. 
If a dog that is subject to vaccination arrives without 
a valid certificate of rabies vaccination, it shall not be 
admitted until this requirement is met as provided in 
the regulations. 

Additional Requirements for Monkeys Only: Anti- 
Yellow Fever Measures. Monkeys arriving from or 
having passed through a yeUow fever infected local 
area, or an area in which there is reason to suspect the 
existence of yellow fever virus, shall be admitted only 
if inspection of the animals reveals no sign of yellow 
fever, and there is evidence satisfactory to the medical 
officer in charge that: (a) at least 9 days have elapsed 
following their departure from the last such area con- 
tacted, or (b) they arrive in a mosquito-proof struc- 
ture, and have been kept in such a structure for at least 
9 days immediately before arrival, or (c) they have an 
effective immunization against yellow fever. 



RPR CARD TEST FOR SYPHILIS SCREENING IN FIELD INVESTIGATIONS 

W. J. Brown, J. F. Donohue, and E. V. Price. Public Health Reports, 
79(6): 496-500, June 1964. 



The rapid plasma reagin (RPR) card test was de- 
scribed by Portnoy, et al., in 1962, as having the neces- 
sary qualities for an effective field test: (a) rapid simple 
method for obtaining plasma from finger stick blood, 
requiring neither water bath nor centrifuge; (b) a stable 
antigen suspension; (c) rapid performance; and (d) 
adequate sensitivity and specificity. 

To evaluate the practicability of the RPR card test 
for use as a screening procedure in field investigations, 
28 nontechnical venereal disease investigators from vari- 
ous sections of the country received a 2-day screening 
course at the Venereal Disease Research Laboratory. 
Communicable Disease Center, Atlanta, Georgia, in the 
performance of the RPR card test. Each investigator 
was given an RPR card testing kit with the following 
instructions; All named contacts to early infectious 
syphilis will be tested by both the RPR card test and 
by the VDRL quantitative slide test. In addition, all 
named contacts will have physical examinations in the 
clinics. For all others tested (suspects, associates, high- 



prevalence groups, and so on) the VDRL sUde test is 
required only if the RPR card test is reactive. 

Between April 1962 and March 1963, 3,920 persons 
were tested by the RPR card test, and on 2,788 of these 
the VDRL quantitative slide test was also performed. 
Among 295 contacts who were reactive to the card test, 
21% were nonreactive to the VDRL; in all others than 
contacts, 25% of 369, who were reactive to the card 
test were nonreactive in the VDRL slide test. Among 
contacts who were nonreactive to the RPR card test, 
97.8% were also nonreactive to the VDRL test, and for 
all others tested this rate was 98.5%. 

Combining reactive and weekly reactive results, there 
was 92.9% agreement between the RPR card test and 
the VDRL slide test in contacts and 93.2% agreement 
in all others tested. Agreement among the 28 investi- 
gators performing the card tests ranged from 73 to 
100%. Among patients diagnosed as syphilitic, the 
RPR card test and VDRL slide test were nonreactive in 
10%; and among persons classified as nonsyphilitic, the 



U.S. NAVY MEDICAL NEWS LETTER 



21 



RPR card test was nonreactive in 94.1% and the 
VDRL slide test was nonreactive in 99.5%, It appears 
that both tests were equal in sensitivity but that the 
VDRL slide test was more specific than the RPR card 
test. However, in untreated primary syphiUs, the stage 
in which serologic tests are subordinate to the darkfield 
in establishing a diagnosis, the RPR card test showed 
greater sensitivity than the VDRL slide test (84.3% 
compared with 71.1% reactive). Both were 100% re- 
active in the secondary stage. In all other syphilitic 
categories, the VDRL slide test was more reactive than 
the RPR card test, reflecting greater confidence in the 
VDRL in establishing a diagnosis. 

One of the principal objectives of this evaluation was 
to determine the reliability of the RPR card test when 
performed by nontechnical personnel. It was found 
that nontechnical personnel compared favorably with 
experienced serologists. It was the consensus of the 
28 investigators that the card test was too cumbersome 
for confidential field investigations. They agreed that 
it was of value in the clinic as an aid in completing the 
diagnosis of contacts on the first clinic visit. Also, since 
only 5 drops of blood are required for the RPR card 
test, it is considered useful in testing babies, 

NOTE: 

1. The RPR card test for Syphilis kit is now standard 
as FSN 6505-985-7224. 

2. The RPR card test was evaluated by the U.S. Navy 
Preventive Medicine Unit No. 2, Norfolk, Virginia, 
and found to be suitable for use as a screening test 
on board ships. — Director, Preventive Medicine 
Div., BuMed. 

WASPS, BEETLES IN CALIFORNIA 

TESTS FOR NATURAL HOUSEFLY 

CONTROL 

Pest Control J., Wasps, Beetles in Calif. Tests for Nat- 
ural Housefly Control, 32(7): 64, July 1964 

California is not the original habitat of the Old 
World housefly, Musca domestica, but ranching prac- 
tices in California help it thrive, despite the South- 
west's dryness. Another great help to houseflies is the 
absence of natural predators. 

To correct this deficiency an entomologist from the 
Riverside campus of the University of Cahfornia, trav- 
eled to the Caribbean Sea area in search of housefly 
predators and found four tiny wasps and a Jamaican 
beetle. 

These insects passed initial screening tests for preda- 
tion and safety of importation and are now being reared 
in large numbers at Riverside. 

First releases of wasps on poultry farms were in 
April, Periodic counts will show whether the wasps are 
preying on houseflies and whether the wasps are repro- 
ducing too. Although they reproduced under laboratory 



conditions, California's naturally dry environment could" 
have a bad effect on them. 

The second insect imported is a beetle which is actu- 
ally a double predator. This beetle, called Aleochara, 
lays its eggs in housefly larvae and also voraciously eats 
eggs and pupae. It has been cultured for the first time 
in Riverside's insectary. 

"Biological control is always a gamble," the ento- 
mologist stated. "There's no positive way to predict if 
these imported beneficial insects will do the job; there 
are many variable factors in this new environment. The 
best we can do is try the insect to see what happens." 

These insects are the most promising ones found so 
far, and chances that they will be able to reduce fly 
populations in heavy fly breeding areas look very good. 



DID YOU KNOW? 

That there has been a significant increase of cases of 
leptospirosis affecting farmers working in fields, planta- 
tions, and fishponds of Upper Galilee? 

E. Nagy and G, Schick, from the Safed Government 
Hospital in Israel report that in 27 of a total of 70 
cases detected in the past 5 years, the infecting agent 
was Leptospira mini Szwaizak. In a lesser number of 
cases L. grippotyphosa was identified. (1) 

That the Supreme Court of Ireland recently upheld 
the constitutionality of the Health (Fluoridation of 
Water) Act of 1960? 

This opinion was rendered after what is called "the 
longest civil action in the history of Ireland." (2) 

That more than twice as many children die each year 
from measles complications as from poliomyelitis? (3) 

That Mexico is no longer considered a yellow-fever 
receptive area? (4) 

That Gout used to be a very rare disease in Japan? 
However, it is becoming more and more common, 
reaching the level of gout incidence and distribution of 
the western countries and the United States. Some 
authorities think that this could be due to the rapidly 
changing way of life in Japan, The clinical picture of 
gout in Japan does not differ at all from that observed 
in other countries. (5) 

That the entire island of Guadalcanal, British Solo- 
mon Islands Protectorate, has been given its first pro- 
tective layer of antimalaria spray? 

Over 5,000 houses have been sprayed, providing pro- 
tection against malaria to more than 15,000 people on 
the island. (6) 

That the little quarter-inch long Stenodus beetle fends 
off attacks from a water spider, a fast, long-legged bug 
that is its customary nemesis, by simply squirting out a 
charge of fluid detergent from a pair of abdominal 
glands? 

The detergent destroys the thin elastic layer of water 
that marks the boundary between fluid and air. With 



22 



U.S. NAVY MEDICAL NEWS LETTER 



that surface tension gone, a small water wave rises and 
propels the Stenodus out of danger. When the attack- 
ing water strider, which is normally supported by the 
film of surface tension, tries to follow, it sinks and 
drowns. The Stenodus exhausts all of its detergent in 
one 45-foot dash, and needs a week or more to replen- 
ish its supply, (7) 

That the ancient Egyptians depicted children as suck- 
ing the index finger and not the thumb? 

Amongst modern Egyptian children, index sucking 
obtains at the present time, but the authors found two 
small offspring of an Egyptian father and a German 
mother sucking thumbs in the usual manner. (8) 

That the noisy, quarrelsome Passer domesticus, the 
English sparrow, has changed his size and color since 
he arrived in North America from Germany and Eng- 
land in 1852? 

His wings and body have changed size, and his color 
tends to be a darker or lighter brown, according to the 
section of the country where he lives. Sparrows from 
the northern and Pacific coastal areas and from the 
Valley of Mexico are darkly pigmented, while those 
from the arid southwestern regions from southern Cali- 
fornia east to southern and central Texas are relatively 
pale in color. 

The sparrow since 1852 has spread to Vancouver 
about 1900, Death Valley in 1914, and Mexico City in 



1953. The rapid evolutionary changes in color and size 
were studied by scientists who collected a series of 100 
to 250 specimens of the English sparrows at various 
localities throughout North America and the Hawaiian 
Islands, Bermuda, England and Germany. (9) 

That strangulated inguinal hernia is exceptionally 
common in the Basoga tribe of the Busoga district of 
Uganda? 

The author, from the Jinja hospital in Soroti, 
Uganda, reports that this condition may be due to the 
prevalence of a congenital direct inguinal hernia, which 
has in the past been generally regarded as a rarity. (10) 
References : 

1. {Harefuah 49: 112, 16 Feb 1964) JAMA, 188(12): 
1099, 22 June 1964. 

2. Mass. Dept of PH, 13(37): 361-370, 14 Sept 1964, 

3. Science News Ltr 85: 268, 25 April 1964. 

4. WHO Wkly Epid Record, 39(26): 309, 26 June 
1964. 

5. JAMA, 189(6): 529, 10 Aug 1964. 

6. Health, Jl of the Dept of Health, Commonwealth 
of Australia, 13(2): 38, June 1963. 

7. Time Mag, 25 Sept 1964. 

8. Brit Med Jour., No. 5379, pp 373-374, 8 Feb 
1964. 

9. Science News Ltr 85: 377, 13 June 1964. 
10. JAMA, 189(3): 251, 20 July 1964. 



TICK PARALYSIS— ARKANSAS 

Morbidity and Mortality Weekly Report, Communicable Disease Center, PHS, 
DREW, Atlanta, Ga., Tick Paralysis- Arkansas, 13(29): 250, 24 July 1964. 



On May 30, 1964, a 58-year-old, white male tele- 
phone lineman developed weakness and paralysis of 
his left hand and arm. The previous night his wife 
had found and attempted to remove a tick from his 
scalp. 

The patient was hospitalized; a physical examina- 
tion demonstrated numerous old tick bites and 5 new 
bites over the left scapular region. The examining 
physician located and removed from his scalp the re- 
mainder of the tick which had been partially removed 
by his wife the previous night. Neurological examina- 
tion showed weakness of the flexor muscles of the left 
arm and opponens function of the left thumb with 
paralysis and mild weakness of extensor muscles as 
well. The patient remained afebrile and a complete 
medical evaluation failed to reveal any underlying 
metabolic or neurologic disease. 

The patient fully recovered within 36 hours after 
complete removal of the tick from his scalp. 
EDITOR'S NOTE (from the above reference) : The 
subject of tick paralysis has been extensively reviewed. 



The usual clinical picture is described as ascending 
flaccid paralysis beginning in the lower extremities 
which may progress to complete paralysis and death 
unless the tick is completely removed. Isolated nerve 
palsies, as would appear to be present in this case, 
also have been described. 

The illness occurs most frequently during the sum- 
mer months when exposure to ticks is most common. 
Poliomyelitis has been a major consideration in the 
differential diagnosis. The absence of fever, muscle 
spasm, and neck stiffness, the lack of spinal fluid 
abnormalities, and the identification of the offending 
tick are usually adequate to clarify this differentiation. 
Following removal of the tick, recovery is dramatically 
rapid, with disappearance of neurologic abnormalities 
usually within 2 days and complete recovery within 
1 week. 

In the United States, most human cases have been 
associated with bites from the wood tick, Dermacentor 
andersoni, in the West and Northwest, and the dog 
tick, Dermacentor variabilis, in the East. 



U.S. NAVY MEDICAL NEWS LETTER 



23 



The substance responsible for the paralysis has not 
been identified but is believed to be a toxin originating 
from saliva of the tick or from ova of the gravid 
female. Thus, care should be taken to completely re- 
move all parts of the tick as rapidly as possible. 



References : 

1. Abbott, K. H.: Tick Paralysis: Review. Proceed- 
ings Mayo Clinic, 18: pp. 39 & 59, February 10 & 
24, 1960. 

2. Stanbury, J. B., and Huyck, J, H.: Tick Paralysis: 
Critical Review, Medicine, 24:219-242, Sept 1945. 




MISCELLANY 



A Look At Our U. S. Naval Hospitals-Guam , 

Mariana Islands 



(Second in a Series)** 



Historical Notes: The history of the Navy's Medical 
Department on Guam began on 20 June 1898, when 
Passed Assistant Surgeon Ammen Farenholt, medical 
officer aboard the USS CHARLESTON, landed with 
the first American Forces on Guam during the Spanish- 
American War. It was not until the spring of 1899 that 
a naval occupational organization in the USS YOSEM- 
ITE arrived at Guam. The medical officers of the ves- 
sel were Surgeon Philip Leach and Assistant Surgeon 
Alfred G. Grenwell. Thus the first Senior Medical OflB- 
cer for the Guam area was Surgeon Leach. 

During this time Navy sick quarters were estabhshed, 
sanitary regulations were effected throughout Agana 
and outlying areas and, on 10 June 1901, the corner- 
stone was laid for the Maria Schroeder hospital in 
Agana. Staffed by Navy Medical Department person- 
nel, the hospital cared for the indigenous population, 
military dependents and naval personnel. In 1905 the 



* Adapted from material in <he hospital's BRIEFING DATA sub- 
mitted by CAPT James G. Kurfees MC USN, Commanding 
OfTicer. 

•• The first in this series was USNH, Yokosulta, Japan — described 
in the Medical News Letters of 7 and 21 August 1964 (Vol. 44, 
Nos. 3 & 4). The latter issue covered at length the history, de- 
velopments and current operations of the Japanese Intern Program 
at USNH, Yokosuka — and the impact the program has had on 
favoratjle Japanese-American medical relations. 



Susana Hospital for women and children was founded. 
Professional services again were furnished by the U.S. 
Navy Medical Department. In the same year islanders 
were vaccinated against smallpox. Another noteworthy 
achievement was the establishment in 1918 of a school 
for the instruction of midwives who were licensed when 
eligible. From 1905 to 1918 there had been 50 cases 
of tetanus neonatorum (umbilical cord infection), all 
of whom died. From 1918 on there were no reports of 
"cord tetanus." An elementary course in hygiene was 
instituted in public schools; and a Tuberculosis Hospital 
was established in 1916 at Agana Heights, near the 
location of the present hospital. 

During the period from December 1941 until July 
1 944 the island of Guam was occupied by forces of the 
Japanese Government. 

Following our re-capture of Guam, Naval medical 
facilities were established in July 1944 as the U.S. Fleet 
Hospital, No. 103, later redesignated as U.S. Naval 
Hospital, Guam in January 1946. In March 1946, the 
U.S. Naval Medical Center, Guam was commissioned 
under a Medical Officer in Command and was com- 
posed of the following activities: U.S. Naval Hospital; 
Guam Memorial Hospital; School of Medical Assist- 
ants; and School of Dental Assistants. In October 1949, 



24 



U.S. NAVY MEDICAL NEWS LETTER 




U. S. NAVAL HOSPITAI^GUAM, MARIANA ISLANDS 
Official Photograph — U.S. Navy by Photographic Laboratory of this Hospital. 



the 22nd Army General Hospital was disestablished and 
the Navy assumed responsibility for care of all Armed 
Forces personnel entitled to hospitalization. On 1 July 
1950, the U.S. Naval Medical Center was disestab- 
lished and the U.S. Naval Hospital, Guam assumed 
functions of the Center. The Schools were subsequendy 
disestablished in February 1951, when responsibility for 
the Civil Government of Guam was transferred to the 
Department of the Interior. 

Public Law 653/80th Congress on 16 June 1948, 
authorized construction of the present permanent hos- 
pital facilities at a cost of $25,000,000. This was sub- 
sequently reduced to $21,000,000 by Public Law 
209/83rd Congress on 7 August 1953, due to utilization 
of Construction Battalion (CB) labor for the construc- 
tion of the Public Housing. At this time, and prior to 
completion of various planned facilities, Navy policy 
concerning contracts for Military Construction projects 
was chaftged from CPFF (cost plus fixed fee) contracts 
to Lump Sum contracts. Bid Invitations were issued 
and Awards made under the new policy for the balance 
of the planned facilities. Total construction cost was 
$14,670,687. This amount has been reduced to the 
present value by transfer of Housing and public works 
type facilities to Public Works Center, Guam as of 
1 September 1960, upon consolidation of the Public 
Works Functions in the Guam Mariana Islands com- 
plex. In 1948 field surveys were made of various loca- 



tions and selection of the present site was made. In 
July 1948, the Architect-Engineer was authorized to 
prepare preliminary design. In March 1950, all design 
was stopped for review for conformity with congres- 
sional austerity concepts. In October 1950, the designs 
were finally approved. In September 1951, the first 
ground was broken and site clearance was begun. In 
July 1952, final plans were received and major con- 
struction commenced. Hospital facilities were moved 
to the present building on 23 October 1954, and the 
formal dedication ceremony was held on 2 November 
1954, with RADM Lamont Pugh, then Chief, Bureau 
of Medicine and Surgery, as the principal speaker. 

During the years the Navy Medical Department was 
responsible for medical care on Guam, great advances 
were made in health and sanitation. Today, diseases 
such as typhoid fever, dengue, leprosy, yaws, and 
gangosa are practically unknown. The general health 
of both military and civilian population is excellent, 
although there is still an extremely high incidence of 
Amyotrophic Lateral Sclerosis — a neurological disease 
of unknown etiology — among native Guamanians, The 
U. S. Public Health Service is conducting an extensive 
study of this and related neurological diseases in this 
area, and it can be expected that much benefit will 
eventually accrue from these studies and research 
efforts. 



U.S. NAVY MEDICAL NEWS LETTER 



25 



Mission. To provide general clinical and hospitaliza- 
tion services for active duty Navy and Marine Corps 
personnel, active duty members of the other armed 
services, dependents of active duty personnel, and other 
authorized persons as outlined in current directives. To 
cooperate with military and civil authorities in matters 
pertaining to health, sanitation, local disasters, and other 
emergencies. 

Task. The following specific tasks are assigned to 
accomplish the mission. 

Provide, train and maintain augmentation personnel 
for immediate availability to the operating forces as 
provided in current instructions. 

Provide general clinical and hospital services to mem- 
bers of the civil population at the request of the 
Government of Guam; the High Commissioner, Trust 
Territories of the Pacific Islands; and the Naval Ad- 
ministrator, Bonin-Volcano Island Group, in accordance 
with current directives. 

Maintain three beds for Veterans Administration 
patients. 

Serve as a collection and transshipment point for air 
and surface evacuation of patient personnel who are 
returned to the Continental United States for medical 
reasons. 



Provide a mobilization capability for casualties re- 
sulting from military action in the entire Far East area. 

Provide, upon request, emergency and disaster medi- 
cal and dental stores to Armed Services shore activities 
and fleet units. 

Conduct a clinical clerkship training program for 
Micronesian doctors. 

Conduct a training program for Micronesian nurses. 

Conduct postgraduate training program for Micro- 
nesian medical personnel. 

Operate and maintain naval cemeteries located at 
Guam. 

Provide mortuary services as required by competent 
authority. 

Provide on-the-job specialty training for Group X 
hospital corpsmen as appropriate. 

Conduct in-service training of Group X hospital 
Corpsmen. 

Regional data processing center for assigned activities. 

Perform care-of-the-dead program under the general 
supervision of the Bureau and in coordination with the 
program administered by the Commandants as outlined 
in current directives. 

Provide or undertake such other appropriate func- 
tions as may be authorized or directed by higher 
authority. 



DEPARTMENT OF THE NAVY 

U. S. NAVAL MEDICAL SCHOOL 

NATIONAL NAVAL MEDICAL CENTER 

BETHESDA 14, MARYLAND 

OFFICIAL BUSINESS 



POSTAGE AND FEES PAID 
NAVY DEPARTMENT 



PERMIT NO. 104B 



■■SDICAL TECHNICAL LIBRART 

'^adiga;^ ar:^y hospital 

TACOilA, WASIJIIv'GTON L 



10-9 



26 



U.S. NAVY MEDICAL NEWS LETTER